from the Immunization Action Coalition — · 1 IAC’s Honor Roll Focuses on Mandatory Influenza...

Volume 15 – Number 4 November 2011

VACCINATE ADULTS!from the Immunization Action Coalition — www.immunize.org

(Content current as of Oct. 24)

What’s Inside?

Immunization questions?• CalltheCDC-INFOContactCenterat(800)232-4636or(800)CDC-INFO

• [email protected]•Callyourstatehealthdept.(phonenumbersatwww.immunize.org/coordinators)

Ask the ExpertsIAC extends thanks to our experts, medical epi-demiologist Andrew T. Kroger, MD, MPH; nurse educator Donna L. Weaver, RN, MN; and medical epidemiologist William L. Atkinson, MD, MPH. All are with the National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC).

Has ACIP recommended the use of high-dose and intradermal influenza vaccines? Yes,ACIPhasrecommendedtheuseofhigh-doseandintradermalinfluenzavaccines,alongwithallotherFDA-approvedtrivalentinactivatedinfluenzavaccines(TIV).ACIPhasnotstatedapreference

(continued on page 14)

Ask the Experts: CDC immunization experts answer your questions ...................................... 1IAC’s Honor Roll Focuses on Mandatory Influenza Vaccination for Healthcare Personnel .......................................................... 2Vaccine Highlights: Recommendations, schedules, and more ......................................... 4Standing Orders for Administering Td/Tdap to Adults ............................................................. 5Temperature Logs for Separate Refrigerator and Freezer Vaccine Storage Units ................... 6IAC’s Storage and Handling Materials ............... 7Influenza Vaccine Products 2011–12 ................ 8How to Administer Intramuscular, Intradermal, and Intranasal Influenza Vaccines ..................... 9Influenza Education Materials ........................... 10Standing Orders for Influenza Vaccines ............ 11Screening Questionnaire for Injectable Influenza Vaccination ......................................... 12Screening Questionnaire for Intranasal Influenza Vaccination ......................................... 13IAC’s Immunization Resources Order Form ...... 15

foranyTIVproductoveranother.Theformulationorpresentationaprovideruses is theprovider’schoice as long as an age-appropriate product isusedandisadministeredcorrectly.Providersneedtochoosethetypeofvaccinemostappropriatefortheir patient population.The ImmunizationAc-tionCoalition(IAC)websitehasmanufacturers’packageinsertsforeveryinfluenzavaccineproductlicensedforU.S.useduringthe2011–12influenzaseason.Gotowww.immunize.org/packageinserts/pi_influenza.asp.

Can you explain the newest recommendation for vaccinating people with egg allergies?Any allergic reaction to eggs severe enough tocausehivesisacontraindicationforLAIV;how-ever, it is only a precaution for receipt ofTIV.Ifthereactionconsistsofhivesonly,thepersonshouldbegivenTIVbyahealthcareproviderwhoisfamiliarwiththepotentialmanifestationsofeggallergy.Thepersonshouldalsobeobserved foratleast30minutesafterbeingvaccinated.Ifthereactionincludesmoreseveresymptoms,includingbutnotlimitedtoswellingofthelipsandthroat,angioedema, lightheadedness, cardiovascularsymptoms(e.g.,hypotension),respiratorysymp-toms(e.g.,wheezing),gastrointestinalsymptoms(e.g.,nausea,vomiting),ahistoryofrequireduseofepinephrinefollowingeggingestion,orahistoryof

requiredemergencymedicalintervention,thenthepatientshouldbereferredtoaphysicianfamiliarwiththemanagementofallergicconditions.

How do you suggest we screen patients for potential egg allergy in our busy clinic?Peoplewhoindicatethattheycaneatlightlycookedeggs (e.g., scrambledeggs)without reactionare

FEDERAL and

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Useagencycode

TheImmunizationActionCoalitionisa501(c)(3)charitableorganizationandyourcontributionistax-deductible

tothefullestextentofthelaw.

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Immunization Action Coalition Receives Major Award from Centers for Disease Control and Prevention TheImmunizationActionCoalition(IAC),pub-lisherofVaccinate Adults,andtheNationalCen-ter for Immunization and Respiratory Diseases(NCIRD)oftheCentersforDiseaseControlandPrevention(CDC)areenteringintoacooperativeagreementwithimportantimplicationsforhealth-careprofessionalsandtheirpatients.Theawardisfor$1.4millionoverfiveyears.

This cooperative agreement will support threeof IAC'scurrentkey functions: (1) creationanddistribution of weekly editions of IAC Express to IAC’s email subscribers; (2) publication of“Ask the Experts,” a forum inwhichCDC andIACimmunizationexpertsanswerquestionsfromhealthcareprofessionalswhoprovideimmuniza-tionservices;and(3)creationofnewimmuniza-tion educationmaterials designed to respond tothe needs of immunization providers, parents,andpatients.Importantly,thenewagreementalsomakesIACthenation’scentralclearinghouseforVaccine Information Statements (VISs) in lan-guages other than English. The award supportscentralcoordinationanddistributionofVIStrans-

lations,aswellastranslationofalimitednumberofVISs.

VISs are the foundation of patient- and parent-centered vaccination delivery.Mandated by theNational Childhood Vaccine Injury Act, theseinformation sheets help ensure that families re-ceive essential information about each vaccineincluding, for example, the vaccine's benefitsandpotential sideeffects.ProperdistributionoftheVISswill informvaccinerecipients,or theirparentsorlegalrepresentatives,aboutthevaccinepriortoreceivingadose.ProvidingthisimportantinformationinawidearrayoflanguagesupholdsIAC’s and CDC/NCIRD’s shared dedication togiving all Americans access to the vaccinationinformationtheyneed.

“ThispartnershipbetweenCDCandIACwillsig-nificantlyimprovetheimmunizationinformationavailable to those patients and parents who arebestcommunicatedwithinlanguagesotherthanEnglish,”saidIAC'sExecutiveDirector,DeborahWexler,MD.

http://www.immunize.org/va

http://www.immunize.org

mailto:[email protected]

http://www.immunize.org/coordinators

http://www.immunize.org/packageinserts/pi_influenza.asp

http://www.immunize.org/packageinserts/pi_influenza.asp

Vaccinate Adults! •November2011•ImmunizationActionCoalition•(651)647-9009•www.immunize.org•www.vaccineinformation.org2

Vaccinate Adults!online at www.immunize.org/va

Immunization Action Coalition1573SelbyAvenue,Suite234

St.Paul,MN55104Phone:(651)647-9009Fax:(651)647-9131

Email:[email protected]:www.immunize.orgwww.vaccineinformation.org

www.izcoalitions.orgVaccinate Adults is a publication of theImmunizationActionCoalition(IAC)writ-ten forhealthprofessionals.Content is re-viewedbytheCentersforDiseaseControlandPrevention(CDC)fortechnicalaccuracy.ThispublicationissupportedbyCDCGrantNo.U38IP000589.Thecontentissolelytheresponsibility of IAC and does not neces-sarilyrepresenttheofficialviewsofCDC.ISSN1526-1824.

Publication StaffEditor:DeborahL.Wexler,MD

AssociateEditor:DianeC.PetersonManagingEditor:DaleThompson,MAEdit./Opr.Asst.:JanelleT.Anderson,MA

Consultants:TeresaA.Anderson,DDS,MPHLindaA.Moyer,RN,andMaryQuirk

Layout:KathyCohenWebsiteDesign:SarahJoy

IAC StaffAssociateDirectorforResearch:SharonG.Humiston,MD,MPHCoordinatorforPublicHealth:

LaurelWood,MPAAsst.totheDirector:JulieMurphy,MAOperationsManager:RobinVanOssOperationsAssistant:CaseyPauly

IAC publishes a free email news service(IAC Express) and two free periodicals(Needle Tips and Vaccinate Adults). Tosubscribe to any or all of them, go towww.immunize.org/subscribe.

IAC, a 501(c)(3) charitable organization,publishespracticalimmunizationinforma-tionforhealthprofessionalstohelpincreaseimmunizationratesandpreventdisease.

The Immunization Action Coalition is also supported by

MerckSharp&DohmeCorp.GlaxoSmithKline•NovartisVaccines

sanofipasteur•Pfizer,Inc.MedImmune,Inc.•CSLBiotherapies

OrthoClinicalDiagnostics,Inc.BaxterHealthcareCorp.

AmericanPharmacistsAssociationMarkandMurielWexlerFoundation

AnonymousManyothergenerousdonors

IACmaintainsstricteditorialindepen-denceinitspublications.

IAC Board of DirectorsStephanie L. Jakim, MD

Olmsted Medical Center

James P. McCord, MDChildren’s Hospital at Legacy Emanuel

Sheila M. Specker, MDUniversity of Minnesota

Debra A. Strodthoff, MDAmery Regional Medical Center

Deborah L. Wexler, MDImmunization Action Coalition

DISCLAIMER:Vaccinate Adults! isavailable toall readers freeofcharge.Someof the information in this issue issupplied tousby theCenters forDiseaseControlandPrevention inAtlanta,Georgia,andsome information is suppliedby third-partysources.The Immuniza-tionActionCoalition(IAC)hasuseditsbesteffortstoaccuratelypublishallofthisinformation,butIACcannotguaranteethattheoriginalinformationassuppliedbyothers iscorrectorcomplete,or that ithasbeenaccuratelypublished.Someof the informationin this issue iscreatedorcompiledbyIAC.Allof the informationin this issue isofa time-criticalnature,andwecannotguarantee thatsomeof the in-formationisnotnowoutdated,inaccurate,orincomplete.IACcannotguaranteethatrelianceontheinformationinthisissuewillcausenoinjury.Beforeyourelyontheinformationinthisissue,youshouldfirstindependentlyverifyitscurrentaccuracyandcompleteness.IACisnotlicensedtopracticemedicineorpharmacology,andtheprovidingoftheinformationinthisissuedoesnotconstitutesuchpractice.AnyclaimagainstIACmustbesubmittedtobindingarbitrationundertheauspicesoftheAmericanArbitrationAssociationinSt.Paul,Minnesota.

Vaccination is themost effective way toprevent influenza transmission in healthcaresettings. Two years ago, on October 9,2009, the ImmunizationAction Coalition(IAC) announced its onlineHonor Roll for Patient Safety (www.immunize.org/honor-roll). TheHonorRoll recognizes hospitals,medicalpractices,professionalorganizations,and government entities that have taken astand for patient safety by adopting policiesendorsingmandatory influenza vaccinationor by implementingmandatory influenzavaccinationpoliciesforallemployees.Intwoyears’ time,more than120 institutions havejoinedtheHonorRoll.

Mandatory Vaccination Policies from Leading Health OrganizationsThe number of professional societies andorganizationsthathaveissuedpolicystatementsinsupportofmandatoryinfluenzavaccinationfor healthcare workers has grown from 1in 2009 to 12 in 2011.To view the currentlistingofpoliciesandpositionstatementsfromleadingorganizationsinmedicine,pediatrics,pharmacy, public health, infectious diseases, andhospital administration, visit IAC’sHonorRoll atwww.immunize.org/honor-roll.Refer to thepositionstatementsof theseleadingmedicalorganizationstohelpyoudevelopandimplementamandatoryinfluenzavaccination policy at your healthcare institution ormedicalsetting.

Honoring Healthcare InstitutionsIACencourages qualifying healthcare organizationsto apply for itsHonorRoll for Patient Safety. Todate,morethan120facilitieshavebeenenrolledforinclusion in theHonorRoll for Patient Safety. Toviewastate-by-statelistingofHonorRolldesigneesand to find specific informationon themandatesoftheenrolledorganizations,visitwww.immunize.org/honor-roll/influenza-mandates.asp.

Tobeincludedin theHonorRoll,anorganization’smandatemust require influenzavaccination for em-ployeesandmustincludeseriousmeasurestopreventtransmissionofinfluenzafromunvaccinatedworkers

IAC’s Honor Roll Focuses on Mandatory Influenza Vaccination for Healthcare Personnel

topatients.Suchmeasuresmightincludeamaskre-quirement,reassignmenttonon-patient-careduties,ordismissaloftheemployee.Tosubmityourinstitution’sapplicationfortheHonorRoll,pleasefillouttheonlineform(www.immunize.org/laws/mandates.aspx).

Toolkits, Journal Articles, and NewsOntheHonorRollpage,IACprovideslinkstotoolkitsthatareintendedtohelpyoudevelopamandatoryin-fluenzavaccinationprograminyourhealthcaresetting.Inaddition,youwillfinda listingofrelatedjournalarticlesandeditorialsfromthemedicalliterature,aswellaslinkstoonlinenewscoverageonthistopic.

Periodically,ourfreeweeklyemailnewsservice,IAC Express, featuresanarticleaboutrecentadditionstotheHonorRoll. WesuggestyousubscribetoIAC Ex-press.Onceyoucompletethesign-upformatwww.immunize.org/subscribe, you’ll start receiving emailannouncementsaboutimportantdevelopmentsrelatedtoimmunization.

www.immunize.org/honor-roll


http://www.vaccineinformation.org





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http://www.immunize.org/express

http://www.immunize.org/nt


http://www.immunize.org/subscribe

http://www.immunize.org/honor-roll



http://www.immunize.org/honor-roll/influenza-mandates.asp

http://www.immunize.org/honor-roll/influenza-mandates.asp

http://www.immunize.org/laws/mandates.aspx





Vaccinate Adults! •November2011•ImmunizationActionCoalition•(651)647-9009•www.immunize.org•www.vaccineinformation.org3Vaccinate Adults! •November2011•ImmunizationActionCoalition•(651)647-9009•www.immunize.org•www.vaccineinformation.org

Advisory BoardLiaisons from Organizations

Bernadette A. Albanese, MD, MPHCouncil of State & Territorial Epidemiologists

William L. Atkinson, MD, MPHNat’l Ctr. for Immun. & Resp. Diseases, CDC

Stephen L. Cochi, MD, MPHNat’l Ctr. for Immun. & Resp. Diseases, CDC

Lawrence J. D’Angelo, MD, MPHSociety for Adolescent Health and Medicine

Paul Etkind, DrPH, MPHNat’l. Assn. of County & City Health Officials

Stanley A. Gall, MDAmer. College of Obstetricians & Gynecologists

Bruce Gellin, MD, MPHNational Vaccine Program Office, DHHS

Neal A. Halsey, MDInstitute for Vaccine Safety, Johns Hopkins Univ.

Claire Hannan, MPHAssociation of Immunization ManagersCarol E. Hayes, CNM, MN, MPHAmerican College of Nurse-Midwives

Gregory James, DO, MPH, FACOFPAmerican Osteopathic Association

Samuel L. Katz, MDPediatric Infectious Diseases Society

Marie-Michele Leger, MPH, PA-CAmerican Academy of Physician Assistants

Harold S. Margolis, MDNat’l Ctr. for Emerg. & Zoonotic Inf. Diseases, CDC

Martin G. Myers, MDNational Network for Immunization Information

Kathleen M. Neuzil, MD, MPHAmerican College of Physicians

Paul A. Offit, MDVaccine Education Ctr., Children’s Hosp. of Phila.

Walter A. Orenstein, MDEmory Vaccine Center, Emory University

Mitchel C. Rothholz, RPh, MBAAmerican Pharmacists Association

Thomas N. Saari, MDAmerican Academy of Pediatrics

William Schaffner, MDInfectious Diseases Society of America

Anne Schuchat, MDNat’l Ctr. for Immun. & Resp. Diseases, CDC

Thomas E. Stenvig, RN, PhDAmerican Nurses Association

Kathryn L. Talkington, MPAffAssn. of State & Territorial Health Officials

Litjen Tan, PhDAmerican Medical AssociationAnn S. Taub, MA, CPNP

National Assn. of Pediatric Nurse PractitionersJohn W. Ward, MD

Division of Viral Hepatitis, NCHHSTP, CDCPatricia N. Whitley-Williams, MD, MPH

National Medical AssociationWalter W. Williams, MD, MPH

Nat’l Ctr. for Immun. & Resp. Diseases, CDC

IndividualsHie-Won L. Hann, MD

Jefferson Medical College, Philadelphia, PAMark A. Kane, MD, MPH

Consultant, Seattle, WAEdgar K. Marcuse, MD, MPH

University of Washington School of MedicineBrian J. McMahon, MD

Alaska Native Medical Center, Anchorage, AKStanley A. Plotkin, MD

Vaxconsult.comGregory A. Poland, MDMayo Clinic, Rochester, MN

Sarah Jane Schwarzenberg, MDUniversity of Minnesota

Coleman I. Smith, MDMinnesota Gastroenterology, Minneapolis, MN

Richard K. Zimmerman, MD, MPHUniversity of Pittsburgh

To order, visit www.immunize.org/shop, or use the order form on page 15.

To receive sample cards, contact us: [email protected]

Now you can give any patient a permanent vaccination record card designed specifically for their age group: child & teen, adult, or lifetime. These brightly colored cards are printed on durable rip-, smudge-, and water-proof paper. To view the cards or for more details, go to www.immunize.org/shop and click on the images.

Wallet-sized immunization record cards for all ages: For adults, for children & teens, and for a lifetime!

Buy 1 box (250 cards) for $45 (first order of a 250-card box comes with a 30-day, money-back guarantee). Discounts for larger orders: 2 boxes $40 each; 3 boxes $37.50 each; 4 boxes $34.50 each

The cost is $17 each for 1–9 copies; $10.25 each for 10–24 copies; $7 each for 25–49 copies; $5.75 each for 50–99 copies.

New

DVD!

The California Department of Public Health, Immunization Branch, updated its award-winning training video, “Immunization Tech-niques: Best Practices with Infants, Children, and Adults.” The 25-minute DVD can be used to train new employees and to refresh the skills of experienced staff on administering injectable, oral, and nasal-spray vaccines to children, teens, and adults. Make sure your healthcare setting has the new 2010 edition!

For healthcare settings in California, contact your local health department immunization program for a free copy.


For 100 or more copies, contact us for discount pricing: [email protected]

"Immunization Techniques — Best Practices with Infants, Children, and Adults"

2011 laminated adult and child immunization schedules — IAC still has supplies available!IAC’s 2012 laminated schedules are anticipated to be available in March. That means the 2011 laminated schedules you order now will still provide you with months of use. Laminated schedules are washable for heavy-duty use, complete with essential footnotes, and printed in color. The cost is $7.50 for each schedule and only $5.50 each for five or more copies.


For 20 or more copies, contact us for discount pricing: [email protected]

The Recommended Immunization Schedules for Persons Ages 0 Through 18 Years are approved by the Advisory Committee on Immunization Practices (www.cdc.gov/vaccines/recs/acip), the American Academy of Pediatrics (www.aap.org), and the American Academy of Family Physicians (www.aafp.org).

•Give PPSV at least 8 weeks after last dose of PCV to children age 2 years or older with certain underlying medical conditions, including a cochlear implant.

6.Inactivatedpoliovirusvaccine(IPV).(Minimum age: 6 weeks)• If 4 or more doses are given prior to age 4 years, an additional dose should be given at age 4

through 6 years.• The final dose in the series should be given on or after the fourth birthday and at least 6 months

following the previous dose.7.Influenzavaccine(seasonal).(Minimum age: 6 months for trivalent inactivated influenza

vaccine [TIV]; 2 years for live, attenuated influenza vaccine [LAIV])• For healthy children age 2 years and older (i.e., those who do not have underlying medical conditions

that predispose them to influenza complications), either LAIV or TIV may be used, except LAIV should not be given to children ages 2 through 4 years who have had wheezing in the past 12 months.

• Give 2 doses (separated by at least 4 weeks) to children ages 6 months through 8 years who are receiving seasonal influenza vaccine for the first time or who were vaccinated for the first time during the previous influenza season but received only 1 dose.

• Children ages 6 months through 8 years who received no doses of monovalent 2009 H1N1 vaccine should receive 2 doses of 2010–11 seasonal influenza vaccine. See MMWR 2010;59(RR-8):33–34.

8.Measles,mumps,andrubellavaccine(MMR). (Minimum age: 12 months) •The second dose may be given before age 4 years, provided at least 4 weeks have elapsed since the first dose.

9.Varicellavaccine. (Minimum age: 12 months) • The second dose may be given before age 4 years, provided at least 3 months have elapsed

since the first dose.•For children ages 12 months through 12 years, the recommended minimum interval between

doses is 3 months. However, if the second dose was given at least 4 weeks after the first dose, it can be accepted as valid.

10.HepatitisAvaccine(HepA). (Minimum age: 12 months) • Give 2 doses at least 6 months apart. • HepA is recommended for children older than age 23 months who live in areas where vaccination

programs target older children, or who are at increased risk for infection, or for whom immunity against hepatitis A is desired.

11.Meningococcalconjugatevaccine,quadrivalent(MCV4). (Minimum age: 2 years) • Give 2 doses of MCV4 at least 8 weeks apart to children ages 2 through 10 years with persistent complement

component deficiency and anatomic or functional asplenia, and 1 dose every 5 years thereafter.•Persons with human immunodeficiency virus (HIV) infection who are vaccinated with MCV4

should receive 2 doses at least 8 weeks apart.•Give 1 dose of MCV4 to children ages 2 through 10 years who travel to countries with highly

endemic or epidemic disease and during outbreaks caused by a vaccine serogroup.• Give MCV4 to children at continued risk of meningococcal disease who were previously

vaccinated with MCV4 or meningococcal polylsaccharide vaccine after 3 years if first dose given at age 2 through 6 years.

This schedule includes recommendations in effect as of December 21, 2010. Any dose not given at the recommended age should be given at a subsequent visit, when indicated and feasible. The use of a combination vaccine generally is preferred over separate injections of its equivalent component vaccines. Considerations should include provider assessment, patient preference, and

Hepatitis B1

AgeVaccine Birth 1 mo 2 mo 4 mo 6 mo 12 mo 15 mo 18 mo 19–23

mo 2–3 yrs

▲▲

DTaP DTaP DTaP

HibHib Hib4

IPV IPV

PCV PCVPCV

Figure 1. Recommended Immunization Schedule for Persons Ages 0 through 6 Years, U.S., 2011

Diphtheria, Tetanus,Pertussis3

Haemophilus influenzae type b4

Inactivated Poliovirus6

Measles, Mumps, Rubella8

Pneumococcal5

Hepatitis A10

Influenza7

Meningococcal11

Varicella9

HepB HepB

MMR

PPSV

HepA (2 doses)

4–6 yrs

Varicella

Rotavirus2 RV RV2RV Range of recommended ages for all children

DTaP

HepA Series

HepB

Hib

IPV

PCV

Influenza (Yearly)

MCV4

Range of recommended ages for certain high-risk groups

1.HepatitisBvaccine(HepB).(Minimum age: birth) Atbirth:

• Give monovalent HepB to all newborns before hospital discharge. • If mother is hepatitis B surface antigen (HBsAg)-positive, give newborn HepB and 0.5 mL of hepatitis

B immune globulin (HBIG) within 12 hours of birth. • If mother’s HBsAg status is unknown, give newborn HepB within 12 hours of birth. Determine mother’s HBsAg

status as soon as possible and, if HBsAg-positive, give newborn HBIG (no later than age 1 week). Dosesfollowingthebirthdose:

• The second dose should be given at age 1 or 2 months. Monovalent HepB should be used for doses given before age 6 weeks.

• Infants born to HBsAg-positive mothers should be tested for HBsAg and antibody to HBsAg 1 to 2 months after completion of at least 3 doses of the HepB series, at age 9 through 18 months (generally at the next well-child visit).

• Administration of 4 doses of HepB to infants is permissible when a combination vaccine containing HepB is given after the birth dose.

• Infants who did not receive a birth dose should receive 3 doses of HepB on a schedule of 0, 1, and 6 months.

• The final (3rd or 4th) dose in the HepB series should be given no earlier than age 24 weeks. 2.Rotavirusvaccine(RV). (Minimum age: 6 weeks)•Give the first dose at age 6 through 14 weeks (maximum age: 14 weeks 6 days). Vaccination should

not be initiated for infants age 15 weeks 0 days or older.• The maximum age for the final dose in the series is 8 months 0 days.•If Rotarix is given at ages 2 and 4 months, a dose at 6 months is not indicated.

3.Diphtheriaandtetanustoxoidsandacellularpertussisvaccine(DTaP).(Minimum age: 6 weeks)

• The fourth dose may be given as early as age 12 months, provided at least 6 months have elapsed since the third dose.

4.Haemophilusinfluenzaetypebconjugatevaccine(Hib). (Minimum age: 6 weeks)•If PRP-OMP (PedvaxHIB or Comvax [HepB-Hib]) is given at ages 2 and 4 months, a dose at age

6 months is not indicated. •Hiberix should not be used for doses at ages 2, 4, or 6 months for the primary series but can be

used as the final dose in children ages 12 months through 4 years. 5.Pneumococcalvaccine.(Minimum age: 6 weeks for pneumococcal conjugate vaccine [PCV];

2 years for pneumococcal polysaccharide vaccine [PPSV]) •PCV is recommended for all children younger than age 5 years. Give 1 dose of PCV to all healthy

children ages 24 through 59 months who are not completely vaccinated for their age.• A PCV series begun with 7-valent PCV (PCV7) should be completed with 13-valent PCV (PCV13). • A single supplemental dose of PCV13 is recommended for all children ages 14 through 59 months

who have received an age-appropriate series of PCV7.•A single supplemental dose of PCV13 is recommended for all children ages 60 through 71 months

with underlying medical conditions who have received an age-appropriate series of PCV7. •The supplemental dose of PCV13 should be given at least 8 weeks after the previous dose of PCV7.

See MMWR 2010;59(No. RR-11).

the potential for adverse events. Providers should consult the relevant Advisory Committee on Immunization Practices statement for detailed recommendations: www.cdc.gov/vaccines/pubs/acip-list.htm. Clinically significant adverse events that follow immunization should be reported to the Vaccine Adverse Event Reporting System (VAERS) at www.vaers.hhs.gov or by telephone, 800-822-7967.

Varicella

DTaP

IPV

MMR

See footnote 3

For those who fall behind or start late, see the catch-up schedule (Table 1).

See footnote 8

See footnote 9

7–10 yrs▲

Figure 2. Recommended Immunization Schedule for Persons Ages 7 through 18 Years, U.S., 2011

Meningococcal3

13–18 yrs11–12 yrsVaccine

Varicella10 Varicella Series

Measles, Mumps, Rubella9 MMR Series

Inactivated Poliovirus8 IPV Series

Hepatitis B7 HepB Series

Tetanus, Diphtheria, Pertussis1

Human Papillomavirus2

Pneumococcal5

Influenza (Yearly)Influenza4

Pneumococcal

Hepatitis A6 HepA Series

Range of recommended ages for all children

Range of recommended ages for catch-up immunization

1.Tetanusanddiphtheriatoxoidsandacellularpertussisvaccine(Tdap). (Minimum age: 10 years for Boostrix and 11 years for Adacel)• Persons ages 11 through 18 years who have not received Tdap should receive a dose followed by Td booster doses every 10 years thereafter.

• Persons ages 7 through 10 years who are not fully immunized against pertussis (including those never vaccinated or with unknown pertussis vaccination status) should receive a single dose of Tdap. Refer to the catch-up schedule if additional doses of tetanus and diphtheria toxoid-containing vaccine are needed.

• Tdap can be given regardless of the interval since the last tetanus and diphtheria toxoid-containing vaccine.

2.Humanpapillomavirusvaccine(HPV).(Minimum age: 9 years)• Quadrivalent HPV vaccine (HPV4) or bivalent HPV vaccine (HPV2) is recommended for the prevention of cervical precancers and cancers in females.

• HPV4 is recommended for prevention of cervical precancers, cancers, and genital warts in females.

• HPV4 may be given in a 3-dose series to males ages 9 through 18 years to reduce their likelihood of acquiring genital warts.

• Give the second dose 1 to 2 months after the first dose and the third dose 6 months after the first dose (at least 24 weeks after the first dose).

3.Meningococcalconjugatevaccine,quadrivalent(MCV4).(Minimum age: 2 years) • Give MCV4 at age 11 through 12 years with a booster dose at age 16 years.

• Give 1 dose at age 13 through 18 years if not previously vaccinated.• Persons who received their first dose at age 13 through 15 years should receive a booster dose at age 16 through 18 years.

• Give 1 dose to previously unvaccinated college freshmen living in a dormitory.• Give 2 doses at least 8 weeks apart to children ages 2 through 10 years with persistent complement component deficiency and anatomic or functional asplenia, and 1 dose every 5 years thereafter.

• Persons with HIV infection who are vacinated with MCV4 should receive 2 doses at least 8 weeks apart.

• Give 1 dose of MCV4 to children ages 2 through 10 years who travel to countries with highly endemic or epidemic disease and during outbreaks caused by a vaccine serogroup.

• Give MCV4 to children at continued risk of meningococcal disease who were previously vaccinated with MCV4 or meningococcal polysaccharide vaccine after 3 years (if first dose given at age 2 through 6 years) or after 5 years (if first dose given at age 7 years or older).

4.Influenzavaccine(seasonal).•For healthy nonpregnant persons ages 7 through 18 years (i.e., those who do not have underlying medical conditions that predispose them to influenza complications), either LAIV or TIV may be used.

•Give 2 doses (separated by at least 4 weeks) to children ages 6 months through 8 years

who are receiving seasonal influenza vaccine for the first time or who were vaccinated for the first time during the previous influenza season but received only 1 dose.

•Children ages 6 months through 8 years who received no doses of monovalent 2009 H1N1 vaccine should receive 2 doses of 2010–11 seasonal influenza vaccine. See MMWR 2010;59(RR-8):33-34.

5.Pneumococcalvaccines.•A single dose of 13-valent pneumococcal conjugate vaccine (PCV13) may be given to children

ages 6 through 18 years who have functional or anatomic asplenia, HIV infection or other immunocompromising condition, cochlear implant or CSF leak. See MMWR 2010;59(No. RR–11).

•The dose of PCV13 should be given at least 8 weeks after the previous dose of PCV7.•Give pneumococcal polysaccharide vaccine at least 8 weeks after the last dose of PCV to children age 2 years or older with certain underlying medical conditions, including a cochlear implant. A single revaccination should be given after 5 years to children with functional or anatomic asplenia or an immunocompromising condition.

6.HepatitisAvaccine(HepA).•Give 2 doses at least 6 months apart.•HepA is recommended for children older than age 23 months who live in areas where vaccination programs target older children, or who are at increased risk for infection, or for whom immunity against hepatitis A is desired.

7.HepatitisBvaccine(HepB).•Give the 3-dose series to those not previously vaccinated. For those with incomplete vaccination, follow the catch-up schedule (Table 1).

•A 2-dose series (separated by at least 4 months) of adult formulation Recombivax HB is licensed for children ages 11 through 15 years.

8.Inactivatedpoliovirusvaccine(IPV).•The final dose in the series should be given on or after the fourth birthday and at least 6 months following the previous dose.

•If both OPV and IPV were given as part of a series, a total of 4 doses should be given, regardless of the child’s current age.

9.Measles,mumps,andrubellavaccine(MMR).•The minimum interval between the 2 doses of MMR is 4 weeks.

10.Varicellavaccine.•For persons ages 7 through 18 years without evidence of immunity (see MMWR 2007;56 [No. RR-4]), give 2 doses if not previously vaccinated or the second dose if only 1 dose has been given.

•For persons ages 7 through 12 years, the minimum interval between doses is 3 months. However, if the second dose was given at least 4 weeks after the first dose, it can be accepted as valid.

•For persons age 13 years and older, the minimum interval between doses is 4 weeks.

▲Age

Range of recommended ages for certain high-risk groups

See footnote 2

For those who fall behind or start late, see the schedule below and the catch-up schedule (Table 1).

This schedule includes recommendations in effect as of December 21, 2010. Any dose not given at the recommended age should be given at a subsequent visit, when indicated and feasible. The use of a combination vaccine generally is preferred over separate injections of its equivalent component vaccines. Considerations should include provider assessment, patient preference, and

the potential for adverse events. Providers should consult the relevant Advisory Committee on Immunization Practices statement for detailed recommendations: www.cdc.gov/vaccines/pubs/acip-list.htm. Clinically significant adverse events that follow immunization should be reported to the Vaccine Adverse Event Reporting System (VAERS) at www.vaers.hhs.gov or by telephone, 800-822-7967.

MCV4

HPV (3-doses) (females)

Tdap Tdap

HPV Series

MCV4MCV4

Information about reporting reactions after immunization is available online at www.vaers.hhs.gov or by telephone, 800-822-7967. Suspected cases of vaccine-preventable diseases should be reported to the state or local health department. Additional information, including precautions and contraindications for immunization, is available from the National Center for Immunization and Respiratory Diseases at www.cdc.gov/vaccines or by telephone, 800-CDC-INFO (800-232-4636).

Recommended Adult Immunization Schedule – United States, 2011

Figure 2. Vaccines that might be indicated for adults, based on medical and other indications

*Covered by the Vaccine Injury Compensation Program.

Recommended if some other risk factor is present (e.g., on the basis of medical, occupational, lifestyle, or other indications)

For all persons in this category who meet the age requirements and who lack evidence of immunity (e.g., lack documentation of vaccination or have no evidence of previous infection)

Indication

Vaccine

▲

▲

Pregnancy

Immunocom- promising conditions (excluding human immuno-deficiency virus [HIV]) 3, 5, 6, 13

Healthcare personnel

Pneumococcal (polysaccharide) 7, 8

Figure 1. Recommended adult immunization schedule, by vaccine and age group

HIV infection 3, 6, 12, 13

CD4+ T lymphocyte count

Diabetes, heartdisease, chroniclung disease,chronic alcoholism

Asplenia 12

(includingelectivesplenectomy and persistent complement

componentdeficiencies)

Kidney failure, end-stage renal disease,receipt ofhemodialysis

Chronic liverdisease

Age group Vaccine ▲▲

19–26 years50–59 years

≥65 years

*Covered by the Vaccine Injury Compensation Program.

Human papillomavirus (HPV) 4,* 3 doses (females)

Pneumococcal (polysaccharide) 7, 8

1 dose

Meningococcal9,* Hepatitis A 10,*

Zoster 5

1 dose

Note: These recommendations must be read with the footnotes that follow; the notes contain the

number of doses, intervals between doses, and other important information.

These schedules indicate the recommended age groups and medical indications for which administration of currently licensed vaccines is commonly indicated for adults ages19

years and older, as of January 1, 2011. For all vaccines being recommended on the adult immunization schedule: a vaccine series does not need to be restarted, regardless of the

time that has elapsed between doses. Licensed combination vaccines may be used whenever any components of the combination are indicated and when the vaccine’s other com-

ponents are not contraindicated. For detailed recommendations on all vaccines, including those used primarily for travelers or that are issued during the year, consult the manufac-

turers’ package inserts and the complete statements from the Advisory Committee on Immunization Practices (www.cdc.gov/vaccines/pubs/acip-list.htm).

27–49 years60–64 years

No recommendation

Varicella 3,*

2 doses

Measles, mumps, rubella (MMR) 6,* 1 or 2 doses

1 dose

1 or more doses

2 dosesHepatitis B11,*

3 doses

1 or 2 doses

Tetanus, diphtheria, pertussis (Td/Tdap) 2,*Substitute one-time dose of Tdap for Td booster; then boost with Td every 10 yrs Td booster every 10 yrs

Hepatitis A 10,*

Human papillomavirus (HPV) 4,*

3 doses for females through age 26 yrs

Tetanus, diphtheria, pertussis (Td/Tdap) 2,* Substitute one-time dose of Tdap for Td booster; then boost with Td every 10 yrs

Td

Hepatitis B 11,*

1 or 2 dosesMeningococcal 9,*

3 doses

Measles, mumps, rubella (MMR) 6,* Contraindicated

1 or 2 doses

Zoster 5

Contraindicated

1 dose

Varicella 3,*Contraindicated

2 doses

Influenza 1,*

1 dose TIV annually1 dose TIV or LAIV annually

≥200 cells/µL<200 cells/µL

Influenza 1,*

1 dose annually

2 doses

1 or more doses

The recommended adult immunization schedule has been approved by the Advisory Committee on Immunization Practices (ACIP),

the American Academy of Family Physicians (AAFP), the American College of Obstetricians and Gynecologists (ACOG), and the American College of Physicians (ACP).

The cost is $17 each for 1–9 copies; $10.25 each for 10–24 copies; $7 each for 25–49 copies; $5.75 each for 50–99 copies.





http://www.immunize.org/shop




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4 Vaccinate Adults! •November2011•ImmunizationActionCoalition•(651)647-9009•www.immunize.org•www.vaccineinformation.org4

Vaccine HighlightsRecommendations, schedules, and more

Subscribe to IAC Express!www.immunize.org/subscribe

Get weekly updates on

vaccine information

whileit’s still news!

All the news we publish in “Vaccine Highlights” will be sent by email to you every Monday. Free!

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IAC publications!

Editor's note: The information in Vaccine High-lights is current as of October 24, 2011.

The next ACIP meetingsAcommitteeof15nationalexperts,theAdvisoryCommittee on Immunization Practices (ACIP)advisesCDContheappropriateuseofvaccines.ACIPmeets3timesayearinAtlanta;meetingsareopentothepublic.Thenextmeetingswillbeheldin2012onFeb.22–23andJune20–21.Formore information, visit www.cdc.gov/vaccines/recs/acip.ACIPperiodicallyissuespublichealthrecom-

mendationsontheuseofvaccines.Clinicianswhovaccinateshouldhaveacurrentsetforreference.PublishedintheMorbidity and Mortality Weekly Report (MMWR),ACIPrecommendationsareeas-ilyavailable.Herearesources:

•DownloadthemfromlinksonIAC’swebsite:www.immunize.org/acip•DownloadthemfromCDC’swebsite:www.cdc.gov/vaccines/pubs/acip-list.htm

Influenza vaccine newsOnAug.26,CDCpublishedACIP’s2011influ-enzarecommendations,“PreventionandControlof Influenza with Vaccines.” To obtain a copyof the recommendations, go to www.cdc.gov/mmwr/pdf/wk/mm6033.pdfandseepages1128–1132.

OnJuly26,CDCreleasedtwoVISsfor2011–12influenzavaccine:onefortrivalentinactivatedin-fluenzavaccine(TIV;injectable)andoneforliveattenuatedinfluenzavaccine(LAIV,nasalspray,FluMist).ToaccesstheVISforTIV,gotowww.immunize.org/vis/vis_flu_inactive.asp.ToaccesstheVISforLAIV,gotowww.immunize.org/vis/vis_flu_live.asp.More thanadozen translationsofthe2011–12influenzaVISsareavailableatthelinksabove.Also on July 26, CDC published a large-print

versionofthe2011–12VISfortrivalentinactivatedinfluenzavaccine(TIV;injectable).Theintentistomakeiteasierforpeoplewithreducedvisionorvi-sualacuitytoreadtheVIS.Toaccessit,gotowww.immunize.org/vis/flu_inactive_large_print.pdf.

Tdap vaccine newsOnOct.21,CDCpublishedACIPrecommenda-tionstitled“UpdatedRecommendationsforUseofTetanusToxoid,ReducedDiphtheriaToxoidandAcellularPertussisVaccine(Tdap)inPreg-nantWomenandPersonsWhoHaveorAnticipateHavingCloseContactwithan InfantAged<12

Months.” The recommendations call for health-care providers to administer Tdap to pregnantwomenwhopreviouslyhavenotreceivedthevac-cine,preferablylateinthesecondtrimester(after20 weeks gestation) or during the third trimes-ter. If not administered during pregnancy,Tdapshouldbeadministeredimmediatelypostpartum.Additionally, to protect infants against pertus-sis,adolescentsandadultswhohavenotalreadyreceived their routineTdapdose, and anticipatehavingclosecontactwithaninfantyoungerthanage 12months, should receive a single dose ofTdap.Ideally,theseadolescentsandadultsshouldreceiveTdap at least 2weeks before beginningclosecontactwith the infant.The recommenda-tions also include information on administeringTdap in these special situations: (1) topregnantwomenwhoaredueforatetanusbooster,(2)topregnantwomenforwoundmanagement,and(3)topregnantwomenwithunknownorincompletetetanusvaccination.Toobtainacopyoftherec-ommendations,seepages1424–1426ofthisdoc-ument:www.cdc.gov/mmwr/pdf/wk/mm6041.pdf.

On Sept. 23, CDC published an article titled“FDAApprovalofExpandedAgeIndicationforaTetanusToxoid,ReducedDiphtheriaToxoidandAcellular Pertussis Vaccine.” The article sum-marizes indications for useof theTdapvaccineBoostrix (GSK), including use in adults age 65yearsandolderwhohavenotpreviouslyreceivedthevaccine.FDAapprovedthisageindicationinJuly 2011.Boostrix is now indicated for use inpeopleage10yearsandolder.Thearticlesum-marizesindicationsandguidanceforuseofbothTdap vaccines licensed for U.S. use, BoostrixandAdacel(sanofipasteur).AccordingtoACIP,either Tdap product may be used in people 65andolder.Toaccessthearticle,gotowww.cdc.gov/mmwr/pdf/wk/mm6037.pdfandseepages1279–1280.

Additional resourcesOn Aug. 25, the Institute of Medicine (IOM)releasedanewreport titled“AdverseEffectsofVaccines:EvidenceandCausality.”Overall, thecommittee concluded that few health problemsare caused by or clearly associated with vac-cines.Toaccessthereport,gotowww.iom.edu/Reports/2011/Adverse-Effects-of-Vaccines-Evi-dence-and-Causality.aspx.

AmericanCollegeofPhysicians’Guide to Adult Immunization (4th Edition: A Team-Based Manual) is available at no cost in electronicand hard-copy formats. The guide is intendedto help internists develop systematic processesfor incorporating immunization in their day-to-day practice. To download the guide, go to

http://immunization.acponline.org. To orderit (supplies may be limited), go to https://www.acponline.org/atpro/timssnet/products/tnt_products.cfm?action=long&primary_id=110510100.

TheuseofmostVaccineInformationState-ments (VISs) is mandated by federal law.Listedbelowarethedatesofthemostcur-rentVISs.CheckyourstockofVISsagainstthislist.IfyouhaveoutdatedVISs,printcur-rentonesfromIAC’swebsiteatwww.immu-nize.org/vis.You’llfindVISsinmorethan30languages.

Current VISs and dates

DTaP/DT/DTP .... 5/17/07Hepatitis A ..... 10/25/11Hepatitis B ...... 7/18/07Hib ................ 12/16/98HPV (Cervarix) ..... 5/3/11HPV (Gardasil) ......5/3/11Influenza (LAIV) ...7/26/11Influenza (TIV) ....7/26/11Japan. enceph. ...3/1/10Meningococcal...10/14/11MMR ................3/13/08

MMRV ..............5/21/10PCV ...................4/16/10PPSV ............... 10/6/09Polio .................. 1/1/00Rabies ............. 10/6/09Rotavirus .......... 12/6/10Shingles ........... 10/6/09Td/Tdap ......... 11/18/08Typhoid ............ 5/19/04Varicella .......... 3/13/08Yellow fever .... 3/30/11






http://www.cdc.gov/vaccines/recs/acip

http://www.cdc.gov/vaccines/recs/acip

http://www.immunize.org/acip

http://www.cdc.gov/vaccines/pubs/acip-list.htm

http://www.cdc.gov/mmwr/pdf/wk/mm6033.pdf


http://www.immunize.org/vis/vis_flu_inactive.asp

http://www.immunize.org/vis/vis_flu_inactive.asp

http://www.immunize.org/vis/vis_flu_live.asp

http://www.immunize.org/vis/vis_flu_live.asp

http://www.immunize.org/vis/flu_inactive_large_print.pdf

http://www.immunize.org/vis/flu_inactive_large_print.pdf




http://www.iom.edu/Reports/2011/Adverse-Effects-of-Vaccines-Evidence-and-Causality.aspx



http://immunization.acponline.org

https://www.acponline.org/atpro/timssnet/products/tnt_products.cfm?action=long&primary_id=110510100




http://www.immunize.org/vis


5

Purpose:Toreducemorbidityandmortalityfromtetanus,diphtheria,andpertussisbyvaccinatingalladultswhomeetthecriteriaestablishedbytheCentersforDiseaseControlandPrevention’sAdvisoryCommitteeonImmunizationPractices.

Policy: Underthesestandingorders,eligiblenursesandotherhealthcareprofessionals(e.g.,pharmacists),whereallowedbystatelaw,mayvaccinateadultswhomeetthecriteriabelow.

Procedure 1.Identifyadultsinneedofvaccinationagainsttetanus,diphtheria,andpertussisbasedonthefollowingcriteria: a. lackofdocumentationofatleast3dosesoftetanus-anddiphtheria-containingtoxoids b. lackofdocumentationofpertussis-containingvaccinegivensinceage7yearsinadultswho

• areyoungerthanage65years,includingpregnantwomeninthethirdorlatesecondtrimester(after20weeksgestation)• areage65yearsorolderwhohaveoranticipatehavingcontactwithaninfantyoungerthanage12monthsorareahealthcareworker

c. completionofa3-doseprimaryseriesoftetanus-anddiphtheria-containingtoxoidswithreceiptofthelastdosebeing10yearsagoorlonger

d. recentdeepanddirtywound(e.g.,contaminatedwithdirt,feces,saliva)andlackofevidenceofhavingreceivedtetanustoxoid- containingvaccineintheprevious5years e. age65yearsorolderandwantingtobeprotectedagainstpertussis

2.Screenallpatientsforcontraindicationsandprecautionstotetanusanddiphtheriatoxoids(Td)and,ifapplicable,pertussisvaccine(Tdap):a.Contraindications: •ahistoryofasevereallergicreaction(e.g.,anaphylaxis)afterapreviousdoseofTdortoaTdorTdapcomponent.Foralistof

vaccinecomponents,gotowww.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/B/excipient-table-2.pdf. •forTdaponly,ahistoryofencephalopathywithin7daysfollowingDTP/DTaPnotattributabletoanotheridentifiablecauseb.Precautions: •historyofGuillain-Barrésyndromewithin6weeksofpreviousdoseoftetanustoxoid-containingvaccine •historyofanarthus-typereactionfollowingapreviousdoseoftetanus-containingand/ordiphtheria-containingvaccine,including

meningococcalconjugatevaccine;defervaccinationuntilatleast10yearshaveelapsedsincethelasttetanus-containingvaccine •moderateorsevereacuteillnesswithorwithoutfever •forTdaponly,progressiveorunstableneurologicdisorder,uncontrolledseizuresorprogressiveencephalopathy

3.ProvideallpatientswithacopyofthemostcurrentfederalVaccineInformationStatement(VIS).Youmustdocument,inthepatient’smedicalrecordorofficelog,thepublicationdateoftheVISandthedateitwasgiventothepatient.Providenon-EnglishspeakingpatientswithacopyoftheVISintheirnativelanguage,ifavailable;thesecanbefoundatwww.immunize.org/vis.

4.Administer0.5mLTdorTdapvaccineintramuscularly(22–25g,1–1½"needle)inthedeltoidmuscle.

5. ProvidesubsequentdosesofeitherTdorTdaptoadultsasfollows: a. tocompletetheprimary3-doseschedule:observeaminimumintervalof4weeksbetweenthefirstandseconddoses,and6months betweenthesecondandthirddoses. b. toboostwithTdaporTdafterprimaryscheduleiscomplete:for Tdap,thereisnominimumintervalfollowingTd;for Td booster, boostroutinelyevery10years. c. Inpregnancy,ifaone-timedoseofTdaphasneverbeenadministered,giveTdapinthethirdorlatesecondtrimester(after20weeks gestation).Ifnotadministeredduringpregnancy,giveTdapinimmediatepostpartumperiod.

6.Documenteachpatient’svaccineadministrationinformationandfollowupinthefollowingplaces:a.Medical chart: Recordthedatethevaccinewasadministered,themanufacturerandlotnumber,thevaccinationsiteandroute,and

thenameandtitleofthepersonadministeringthevaccine.Ifvaccinewasnotgiven,recordthereason(s)fornon-receiptofthevaccine(e.g.,medicalcontraindication,patientrefusal).

b. Personal immunization record card:Recordthedateofvaccinationandthename/locationoftheadministeringclinic.

7. Bepreparedformanagementofamedicalemergencyrelatedtotheadministrationofvaccinebyhavingawrittenemergencymedicalprotocolavailable,aswellasequipmentandmedications.

8.ReportalladversereactionstoTdandTdapvaccinestothefederalVaccineAdverseEventReportingSystem(VAERS)at www.vaers.hhs.govor(800)822-7967.VAERSreportformsareavailableatwww.vaers.hhs.gov.

Thispolicyandprocedureshallremainineffectforallpatientsofthe___________________________untilrescindedoruntil__________________(date).

MedicalDirector’ssignature:____________________________________________Effectivedate:_____________________

Standing Orders for Administering Td/Tdap to Adults

www.immunize.org/catg.d/p3078.pdf • Item #P3078 (9/11)

(nameofpracticeorclinic)

Immunization Action Coalition • 1573 Selby Ave. • St. Paul, MN 55104 • (651) 647-9009 • www.immunize.org • www.vaccineinformation.org

Technical content reviewed by the Centers for Disease Control and Prevention, September 2011.

For standing orders for other vaccines, go to www.immunize.org/standing-orders

6 Vaccinate Adults! •November2011•ImmunizationActionCoalition•(651)647-9009•www.immunize.org•www.vaccineinformation.org

New! Temperature Logs for Separate Refrigerator and Freezer Vaccine Storage Units These logs are ready for you to download, copy, and use!

Temperature Log for Refrigerator — FahrenheitCompleting this temperature log: Check the temperature in the refrigera-tor compartment of your vaccine storage unit at least twice each working day. Place an “X” in the box that corresponds with the temperature, the time of the temperature reading, and your initials. Once the month has ended, save each month’s completed form for 3 years, unless state or local jurisdictions require a longer time period.

If the recorded temperature is warmer than 46ºF or colder than 35ºF: this represents an unacceptable temperature range. You must take action!

Month/Year:___________________ Days 1–15

Distributed by the Immunization Action Coalition • (651) 647-9009 • www.immunize.org • www.vaccineinformation.org • [email protected]

www.immunize.org/catg.d/p3037F.pdf • Item #P3037F (8/11) Technical content reviewed by the Centers for Disease Control and Prevention, August 2011.

Take Action!If temperature is too warm (above 46oF) or too cold (below 35oF):1. Store the vaccine under proper conditions as quickly as possible. 2. Temporarily mark exposed vaccine “do not use” until you have verified whether or not the vaccine may be used. 3. Call the immunization program at your state or local health department and/or the vaccine manufacturer to determine whether the potency of the vaccine(s) has been affected: (_______) ______________________. 4. Document the action taken on the reverse side of this log.

ºF

Adapted with appreciation from California Department of Public Health

Staff Initials

Day of Month

Room Temp.

Exact Time am pm am pm am pm am pm am pm am pm am pm am pm am pm am pm am pm am pm am pm am pm am pm

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

See back for “Vaccine Storage Troubleshooting Record”

Danger! Temperatures above 5oF are too warm! Write any unacceptable temperature on the lines above* and call your VFC Rep immediately!

*Write any unacceptable temps (above 46oF or below 35oF) on these lines. Then take action!

46ºF 45ºF

44ºF

43ºF

42ºF

41ºF

40ºF

39ºF

38ºF

37ºF 36ºF

35ºFAcc

ep

tab

le T

em

pe

ratu

res

Danger! Temperatures above 46ºF are too warm! Write any unacceptable temperature on the lines above* and call your state or local health department immediately!

Danger! Temperatures below 35ºF are too cold! Write any unacceptable temperature on the lines above* and call your state or local health department immediately!

Temperature Log for Refrigerator — CelsiusCompleting this temperature log: Check the temperature in the refrigera-tor compartment of your vaccine storage unit at least twice each working day. Place an “X” in the box that corresponds with the temperature, the time of the temperature reading, and your initials. Once the month has ended, save each month’s completed form for 3 years, unless state or local jurisdictions require a longer time period.

If the recorded temperature is warmer than 8ºC or colder than 2ºC: this represents an unacceptable temperature range. You must take action!

Month/Year:___________________ Days 1–15


www.immunize.org/catg.d/p3037C.pdf • Item #P3037C (8/11) Technical content reviewed by the Centers for Disease Control and Prevention, August 2011.

Take Action!If temperature is too warm (above 8oC) or too cold (below 2oC):1. Store the vaccine under proper conditions as quickly as possible. 2. Temporarily mark exposed vaccine “do not use” until you have verified whether or not the vaccine may be used. 3. Call the immunization program at your state or local health department and/or the vaccine manufacturer to determine whether the potency of the vaccine(s) has been affected: (_______) ______________________. 4. Document the action taken on the reverse side of this log.

ºC


Staff Initials

Day of Month

Room Temp.


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

See back for “Vaccine Storage Troubleshooting Record”

*Write any unacceptable temps (above 8oC or below 2oC) on these lines. Then take action!

Danger! Temperatures above 5oF are too warm! Write any unacceptable temperature on the lines above* and call your VFC Rep immediately! 8ºC

7ºC

6ºC

5ºC

4ºC

3ºC

2ºC

Danger! Temperatures above 8ºC are too warm! Write any unacceptable temperature on the lines above* and call your state or local health department immediately!

Danger! Temperatures below 2ºC are too cold! Write any unacceptable temperature on the lines above* and call your state or local health department immediately!

Acc

epta

ble

Tem

pera

ture

s

Temperature Log for Freezer — FahrenheitCompleting this temperature log: Check the temperature in the freezer com-partment of your vaccine storage unit at least twice each working day. Place an “X” in the box that corresponds with the temperature, the time of the tempera-ture reading, and your initials. Once the month has ended, save each month’s completed form for 3 years, unless state or local jurisdictions require a longer time period.

If the recorded temperature is warmer than 5º: this represents an unac-ceptable temperature range. You must take action!

Month/Year:___________________ Days 1–15


www.immunize.org/catg.d/p3038F.pdf • Item #P3038F (8/11) Technical content reviewed by the Centers for Disease Control and Prevention, August 2011.

Take Action!If temperature is too warm (above 5oF):1. Store the vaccine under proper conditions as quickly as possible. 2. Temporarily mark exposed vaccine “do not use” until you have verified whether or not the vaccine may be used. 3. Call the immunization program at your state or local health department and/or the vaccine manufacturer to determine whether the potency of the vaccine(s) has been affected: (_______) ______________________. 4. Document the action taken on the reverse side of this log.

ºF



*Write any unacceptable temps (above 5oF) on these lines. Then take action!

Staff Initials

Day of Month

Room Temp.


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

5ºF 4ºF

3ºF

2ºF

1ºF

0ºF

-1ºF

-2ºF

-3ºF

-4ºF

-5ºF to -30ºF and colder†A

cce

pta

ble

Te

mp

era

ture

s

Danger! Temperatures above 5ºF are too warm! Write any unacceptable temperature on the lines above* and call your state or local health department immediately!

See back for “Vaccine Storage Troubleshooting Record”†Some frozen vaccines must not be stored colder than -58oF. Check the Prescribing Information on the vaccine manufacturer’s website for specific storage temperature instructions.

Temperature Log for Freezer — CelsiusCompleting this temperature log: Check the temperature in the freezer com-partment of your vaccine storage unit at least twice each working day. Place an “X” in the box that corresponds with the temperature, the time of the tempera-ture reading, and your initials. Once the month has ended, save each month’s completed form for 3 years, unless state or local jurisdictions require a longer time period.

If the recorded temperature is warmer than -15ºC: this represents an unac-ceptable temperature range. You must take action!

Month/Year:___________________ Days 1–15


www.immunize.org/catg.d/p3038C.pdf • Item #P3038C (8/11) Technical content reviewed by the Centers for Disease Control and Prevention, August 2011.

Take Action!If temperature is too warm (above -15oC):1. Store the vaccine under proper conditions as quickly as possible. 2. Temporarily mark exposed vaccine “do not use” until you have verified whether or not the vaccine may be used. 3. Call the immunization program at your state or local health department and/or the vaccine manufacturer to determine whether the potency of the vaccine(s) has been affected: (_______) ______________________. 4. Document the action taken on the reverse side of this log.

ºC


*Write any unacceptable temps (above -15oC) on these lines. Then take action!

Staff Initials

Day of Month

Room Temp.


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15


-15ºC

-16ºC

-17ºC

-18ºC

-19ºC

-20ºC

-21ºC

-22ºC

-23ºC to -40ºC

and colder†Acc

ep

tab

le T

em

pe

ratu

res

Danger! Temperatures above -15ºC are too warm! Write any unacceptable temperature on the lines above* and call your state or local health department immediately!

See back for “Vaccine Storage Troubleshooting Record”†Some frozen vaccines must not be stored colder than -50oC. Check the Prescribing Information on the vaccine manufacturer’s website for specific storage temperature instructions.

Refrigerator — Fahrenheit: www.immunize.org/catg.d/p3037f.pdf

Refrigerator — Celsius: www.immunize.org/catg.d/p3037c.pdf

Freezer — Fahrenheit: www.immunize.org/catg.d/p3038f.pdf

Freezer — Celsius: www.immunize.org/catg.d/p3038c.pdf

Also available — vaccine temperature logs for combined refrigerator/freezer units

Refrigerator/freezer — Fahrenheit: www.immunize.org/catg.d/p3039f.pdf Refrigerator/freezer — Celsius: www.immunize.org/catg.d/p3039c.pdf



http://www.immunize.org/catg.d/p3037f.pdf

http://www.immunize.org/catg.d/p3078a.pdf

http://www.immunize.org/catg.d/p3037c.pdf











Vaccinate Adults! •November2011•ImmunizationActionCoalition•(651)647-9009•www.immunize.org•www.vaccineinformation.org 7

Don’t Be Guilty of These Errors in Vaccine Storage and Handling


The following are frequently reported errors in vaccine storage and handling. Some of these errors are much more serious than others, but none of them should occur. Be sure your clinic or practice is not making errors such as these.


Technical content reviewed by the Centers for Disease Control and Prevention, April 2011.

Error #1: Designating only one person, rather than at least two, to be responsible for storage and handling of vaccinesSince vaccines are both expensive and fragile, everyone in the office should know the basics of vaccine handling, including what to do when a shipment arrives and what to do in the event of an equipment failure or power outage. It’s very important to train at least one back-up person in all aspects of proper storage and handling of vaccines. The back-up and primary persons should be equally familiar with all aspects of vaccine storage and handling, including know-ing how to handle vaccines when they arrive, how to properly record refrigera-tor and freezer temperatures, and should be prepared to lead the response to an equipment problem or power outage.

Error #2: Refrigerating vaccine in a manner that could jeopar-dize its qualityThe temperature in the vegetable bins, on the floor, next to the walls, in the door, and near the cold air outlet from the freezer may differ significantly from the temperature in the body of the refrigerator: do not store your vaccines or place thermometers in these locations. Always store vaccines in their original packag-ing in the body of the refrigerator away from these locations, and place your thermometer with the vaccines. Place vaccine packages in such a way that air can circulate around the compartment. Never overpack a refrigerator compartment.

Error #3: Storing food and drinks in the vaccine refrigerator Frequent opening of the refrigerator door to retrieve food items can adversely affect the internal temperature of the unit and damage vaccines.

Error #4: Inadvertently leaving the refrigerator or freezer door open or having inadequate sealsRemind staff to close the unit doors tightly each time they open them. Also, check the seals on the doors on a regular schedule, and if there is any indication the door seal may be cracked or not sealing properly, have it replaced. Replac-ing a seal is much less costly than replacing a box of pneumococcal conjugate or varicella vaccine.

Error #5: Storing vaccine in a dorm-style refrigeratorAll vaccines should be stored in a refrigerator and/or freezer unit that is designed specifically for the storage of biologics or, alternatively, in a separate free-stand-ing unit. A dorm-style combination refrigerator-freezer unit with just one exte-rior door has been shown to be unacceptable no matter where the vaccine was placed inside the unit. Small stand-alone refrigerator or freezer units are best for short-term storage needs.

Error #6: Recording temperatures only once per dayTemperatures fluctuate throughout the day. Temperatures in the refrigertor and freezer should be checked at the beginning and end of the day to determine if the unit is getting too cold or too warm. Ideally, you should have continuous thermometers that record temperatures all day and all night; those with alarms can alert you when temperatures go out of range. A less expensive alternative is to purchase maximum/minimum thermometers. Only thermometers with a Current Certificate of Traceability and Calibration* should be used for vaccine storage. It’s also a good idea to record the room temperature on your temper-ature log in case there is a problem with the storage unit. This information may

be helpful to the vaccine manufacturer and/or state immunization program in determining whether your vaccine is still usable.

Error #7: Recording temperatures for only the refrigerator or freezer, rather than bothIt is essential to monitor and record temperatures in all refrigerators and freez-ers used to store vaccine. At all times you should have calibrated thermometers in the refrigerators as well as the freezers. Assure that your storage tempera-ture monitoring is accurate by purchasing thermometers that have a Certificate of Traceability and Calibration* and recalibrate them according to the manufac-turer’s instructions. Your state immunization program may be able to provide more information on calibrated thermometers.

Error #8: Documenting out-of-range temperatures on vaccine temperature logs but not taking actionDocumenting temperatures is not enough. Acting on the information is es-sential! So, what should you do? Notify your supervisor whenever you have an out-of-range temperature. Sometimes the solution is as simple as shutting a door left ajar or re-checking a freezer temperature that is slightly elevated as it goes through a normal, brief defrost cycle. Check the condition of the unit for problems. Are the seals on the door tight? Is there excessive lint or dust on the coils? After you have made any adjustment, document the date, time, tem-perature, the nature of the problem, the action you took, and the results of your action. Recheck the temperature every two hours. Call maintenance or a repair person if the temperature is still out of range. If the solution is not quick and easy, you will need to safeguard your vaccines by moving them to another storage unit that is functioning at the proper temperature. Label the affected vaccines “Do not use” and contact your state immunization program or vac-cine manufacturer to find out if the affected vaccine is still usable. Be sure to notify your state’s VFC Program Coordinator if VFC vaccine was involved.

Error #9: Discarding temperature logs at the end of every monthIt’s important that you keep your temperature logs for at least three years. As your refrigerator or freezer ages, you can track recurring problems. If out-of-range temperatures have been documented, you can determine how long and how often this has been happening and take appropriate action. It’s also a great way to demonstrate why you need a new refrigerator or freezer.

Error #10: Discarding multi-dose vials 30 days after they are openedDon’t discard your multi-dose vials of vaccines prematurely. Almost all multi-dose vaccine vials contain a preservative and can be used until the expiration date on the vial unless there is actual contamination or the vials are not stored under appropriate temperatures. However, you must discard multi-dose vials of reconstituted vaccine (e.g., meningococcal polysaccharide, yellow fever) if they are not used within a defined period after reconstitution. Refer to the vaccine package inserts for detailed information.

Error #11: Not having emergency plans for a power outage or natural disasterEvery clinic should have a written Emergency Response Plan that identifies a refrigerator and freezer in another location (ideally, a storage unit with a back-up generator) in which to store vaccine in the event of a power outage or natural disaster. Consider arranging in advance for a local hospital or simi-lar facility to be your back-up location if you should need it. Be sure back-up location staff understand vaccine storage and will allow you to supervise place-ment and verify storage temperatures so vaccine is not damaged.

*A calibrated thermometer with a Certificate of Traceability and Calibration with calibra-tion measurements traceable to a testing laboratory accredited by the International Organization of Standardization, to the Standards of the National Institute of Standards and Technology, or to another internationally recognized standards agency.

Follow these procedures:1. Close the door tightly and/or plug in the refrigerator/freezer.

2. Ensure the vaccine is kept at appropriate temperatures. Make sure the refrigerator/freezer is working properly or move the vaccines to a unit that is. Do not discard the affected vaccines. Mark the vaccines so that the potentially compromised vaccines can be easily identified.

3. Notify the local or state health department or call the manufacturer (see manufacturers’ phone numbers below).

4. Record action taken.

Record this information*:1. Temperature of refrigerator: current______ max.______ min.______

2. Temperature of freezer: current______ max.______ min.______

3. Air temperature of room where refrigerator is located:______

4. Estimated amount of time the unit’s temperature was outside normal range:

refrigerator _______ freezer ________

5. Vaccines in the refrigerator/freezer during the event (use the table below)

Emergency Response Worksheet


What to do in case of a power failure or another event that results in vaccine storage outside of the recommended temperature range

* Using a recording thermometer is the most effective method of tracking the refrigerator and freezer temperatures over time. Visually checking thermometers twice a day is an effective method to identify inconsistent or fluctuating temperatures in a refrigerator and freezer.

Adapted by the Immunization Action Coalition, courtesy of the Michigan Department of Community Health

Other Conditions

1. Prior to this event, was the vaccine exposed to temperatures outside the recommended range? Y N

2. Were water bottles in the refrigerator and ice packs in the freezer at the time of this event? Y N

3. Other: _____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

ManufacturersCrucell Vaccines Inc. (800) 533-5899CSL Biotherapies, Inc. (888) 435-8633GlaxoSmithKline (888) 825-5249MedImmune, Inc. (877) 633-4411Merck & Co., Inc. (800) 672-6372Novartis Vaccines (800) 244-7668Pfizer Inc. (800) 438-1985sanofi pasteur (800) 822-2463

Other Resources

Local health department phone number ____________________________ State health department phone number _____________________________

Vaccines Stored in Refrigerator

Vaccine, manufacturer, and lot #

Expiration date

# of doses # of affected vials

Vaccines Stored in Freezer

Vaccine, manufacturer, and lot #

Expiration date

# of doses# of affected

vials


Action taken

Action taken

Technical content reviewed by the Centers for Disease Control and Prevention, October 2010.

Establish Storage and Handling Policies 1. We have designated a primary vaccine coordinator and at least one back-up coordinator to be in charge of vaccine storage and handling at our facility.

2. Both the primary and back-up vaccine coordinator(s) have completely reviewed either CDC's online vaccine storage and handling guidance or equivalent training materials offered by our state health department's immunization program.

3. We have detailed, up-to-date, written policies for general vaccine management, including policies for routine activities and an emergency vaccine-retrieval-and-storage plan for power outages and other problems. Our policies are based on CDC's vaccine storage and handling guidance and/or on instruction from our state or local health department's immunization program.

4. We review these policies with all staff annually and with new staff, including temporary staff, when they are hired.

Log In New Vaccine Shipments 5. We maintain a vaccine inventory log that we use to document the following:

a. Vaccine name and number of doses received

b. Date we received the vaccine

c. Condition of vaccine when we received it

d. Vaccine manufacturer and lot number

e. Vaccine expiration date

Use Proper Storage Equipment 6. We store vaccines in refrigerator and freezer units designed specifically for storing biologics, including vaccines. Alternatively, we keep frozen and refrigerated vaccines in separate, free-standing freezer and refrigerator units. At a minimum, we use a household-style unit with a separate exterior door for the freezer and separate thermostats for the freezer and refrigerator. We do NOT use a dormitory-style unit (a small combination freezer-refrigerator unit with a freezer compartment inside the refrigerator).

7. We use only calibrated thermometers with a Certificate of Traceability and Calibration* that are recalibrated as recommended by the manufacturer.

8. We have planned back-up storage unit(s) in the event of a power failure or other unforseen event. We perform regular maintenance to assure optimal functioning.

Ensure Optimal Operation of Storage Units 9. We have a "Do Not Unplug" sign next to the electrical outlets for the refrigerator and freezer and a "Do Not Stop Power" warning label by the circuit breaker for the electrical outlets. Both include emergency contact information.

10. We keep the storage unit clean, dusting the coils and cleaning beneath it every 3–6 months.

Checklist for Safe Vaccine Storage and HandlingHere are the most important things you can do to safeguard your vaccine supply. Are you doing them all? Review this list to see where you might make improvements in your vaccine management practices. Fill in each box with either or .


Immunization Action Coalition • 1573 Selby Ave. • St. Paul, MN 55104 • (651) 647-9009 • www.vaccineinformation.org • www.immunize.org

Technical content reviewed by the Centers for Disease Control and Prevention, July 2011.

YES NO

YES NO

*Certificate of Traceability and Calibration with calibration measurements traceable to a testing laboratory accredited by the International Organiza-tion of Standardization, to the standards of the National Institute of Standards and Technology, or to another internationally recognized standards agency.

YES NO

YES NO

YES NO

YES NO

YES NO

YES NO

YES NO

YES NO

YES NO

YES NO

YES NO

YES NO

YES NO

Maintain Correct Temperatures 11. We always keep at least one accurate calibrated thermometer (+/-1ºC [+/-2ºF]) with the vaccines in the refrigerator; ideally, we have a continuous-temperature logger and/or temperature-sensitive alarm system.

12. We maintain the refrigerator temperature at 35–46ºF (2–8ºC), and we aim for 40ºF (5ºC).

YES NO

YES NO

(Maintain Correct Temperatures continued on page 2)

Use IAC’s Storage and Handling Materials to Help Safeguard Your Valuable Vaccine SupplyThese materials are ready for you to download, copy, and use!

Manage vaccine inventories. Inventory your vaccine supplies at least monthly and before placing an order. Expired vaccine must never be used and is money wasted!

Always use the vaccine with the soonest expiration date first. Move vaccine with the soonest expiration date to the front of the storage unit and mark it to be used first. Keep vaccine vials in their original boxes.

Store vaccine appropriately.†

Place vaccines in refrigerator or freezer immediately upon receiving shipment. Place vaccine in clearly labeled wire baskets or other open containers with a 2–3" separation be-tween baskets and from wall of unit. Separate VFC-supplied vaccines from vaccines that are privately purchased. Do not store vaccines in the door or on the floor of the unit.

Stabilize temperatures.Store ice packs in the freezer and large jugs of water in the refrigerator along with the vaccines. This will help maintain a stable, cold temperature in case of a power failure or if the re-frigerator or freezer doors are opened frequently or left open. Frequent opening of either the refrigerator or freezer door can lead to temperature variations inside, which could affect vaccine efficacy. For this reason you should not store food or beverages in the refrigerator or freezer.

Safeguard the electrical supply to the refrigerator. Make sure the refrigerator and freezer are plugged into outlets in a protected area where they cannot be disconnected ac-cidentally. Label the refrigerator, freezer, electrical outlets, fuses, and circuit breakers on the power circuit with informa-tion that clearly identifies the perishable nature of vaccines and the immediate steps to be taken in case of interruption of power. If your building has auxiliary power, use the outlet supplied by that system.

Vaccine Handling TipsOutdated or improperly stored vaccines won’t protect patients!

*MMR may be stored in either the freezer or the refrigerator.†Refer to package insert for specific instructions on the storage of each vaccine. If you have questions about the condition of the vaccine upon arrival, you should immediately place the vaccine in recommended storage, mark it “do not use,” and then call your state health department or the vaccine manufacturer(s) to determine whether the potency of the vaccine(s) has been affected. For other questions, call the immunization program at your state or local health department.

Record your health department’s phone number here:



Technical content reviewed by the Centers for Disease Control and Prevention, March 2011.

DTaP, Tdap, Td, DTHibHepatitis A Hepatitis B Human papillomavirus

Influenza (TIV/LAIV) Polio (IPV) MMR* Meningococcal (MCV4 & MPSV4)

Pneumococcal

(PPSV & PCV13)

Rotavirus Maintain refrigerator temperature at 35–46°F (2–8°C)

MMR*MMRVVaricellaZoster

Maintain freezer temperature at 5°F (-15°C) or colder

FreezerRefrigerator


www.immunize.org/catg.d/p2091.pdf • Item #P2091 (3/11)Credit: IAC thanks the Indiana State Department of Health.


www.immunize.org/catg.d/p2090.pdf • Item #P2090 (3/11)Credit: IAC thanks the Indiana State Department of Health.

Checklist for Safe Vaccine Storage and Handling: www.immunize.org/catg.d/p3035.pdfVaccine Handling Tips: www.immunize.org/catg.d/p3048.pdf Do Not Stop Power to Circuit Breaker (sign): www.immunize.org/catg.d/p2091.pdfDo Not Unplug (sign): www.immunize.org/catg.d/p2090.pdf Don't Be Guilty of These Errors in Vaccine Storage and Handling: www.immunize.org/catg.d/p3036.pdf Emergency Response Worksheet: www.immunize.org/catg.d/p3051.pdf




http://www.immunize.org/catg.d/p3036.pdf
















8

Manufacturer Trade Name How SuppliedMercury Content (µgHg/0.5mL)

Age Group Product Code1

CSL Biotherapies Afluria (TIV)2

0.5 mL (single-dose syringe) 09 years & older3

90656

5.0 mL (multi-dose vial) 24.590658Q2035 (Medicare)

GlaxoSmithKline Fluarix (TIV) 0.5 mL (single-dose syringe) 0 3 years & older 90656

ID Biomedical Corp of Quebec, a subsidiary of GlaxoSmithKline

FluLaval (TIV) 5.0 mL (multi-dose vial) 25 18 years & older90658 Q2036 (Medicare)

MedImmune FluMist (LAIV)2 0.2 mL (single-use nasal spray) 0 2 through 49 years 90660

Novartis Vaccines Fluvirin (TIV) 0.5 mL (single-dose syringe) <14 years & older

90656

5.0 mL (multi-dose vial) 2590658 Q2037 (Medicare)

sanofi pasteur Fluzone (TIV) 0.25 mL (single-dose syringe) 0 6 through 35 months 90655

5.0 mL (multi-dose vial) 25 6 through 35 months 90657

0.5 mL (single-dose syringe) 0 3 years & older 90656

0.5 mL (single-dose vial) 0 3 years & older 90656

5.0 mL (multi-dose vial) 25 3 years & older90658 Q2038 (Medicare)

Fluzone High-Dose (TIV) 0.5 mL (single-dose syringe) 0 65 years & older 90662

Fluzone Intradermal (TIV)0.1 mL (single-dose microinjec-tion system)

0 18 through 64 years 90654

Influenza Vaccine Products for the 2011–12 Influenza SeasonInformation about influenza vaccine products


1. Effective for claims with dates of service on or after 1/1/2011, CPT code 90658 is no longer payable for Medicare; rather, HCPCS Q codes (as indicated above) should be submitted for Medicare payment purposes.

2. TIV is the abbreviation for trivalent inactivated influenza vaccine (injectable); LAIV is the abbreviation for live attenuated influenza vaccine (nasal spray).

3. On August 6, 2010, ACIP recommended that Afluria not be used in children younger than age 9 years. If no other age-appropriate TIV is available, Afluria may be considered for a child age 5 through 8 years at high risk for influenza complications, after risks and benefits have been discussed with the parent or guardian. Afluria should not be used in children younger than age 5 years. This recommendation continues for the 2011–2012 influenza season.


Immunization Action Coalition • 1573 Selby Avenue • Saint Paul, MN 55104 • (651) 647-9009 • www.immunize.org • www.vaccineinformation.org • [email protected]

9

1. FluMist (LAIV) is for intranasal administration only. Do not inject FluMist.

2. Remove rubber tip protector. Do not remove dose-divider clip at the other end of the sprayer.

3. With the patient in an upright position (i.e., head not tilted back), place the tip just inside the nostril to ensure LAIV is delivered into the nose. The patient should breathe normally.

4. With a single motion, depress plunger as rapidly as possible until the dose-divider clip prevents you from going further.

5. Pinch and remove the dose-divider clip from the plunger.

6. Place the tip just inside the other nostril, and with a single motion, depress plunger as rapidly as possible to deliver the remaining vaccine.

7. Dispose of the applicator in a sharps container.

Technical content reviewed by the Centers for Disease Control and Prevention, October 2011. www.immunize.org/catg.d/p2024.pdf • Item #P2024 (10/11)

How to administer intramuscular, intradermal, and intranasal influenza vaccines

Intramuscular injection Trivalent Inactivated Influenza Vaccines (TIV)

Intradermal administration Trivalent Inactivated Influenza Vaccine (TIV)

dose-divider clip

Intranasal administration Live Attenuated Influenza Vaccine (LAIV)

1. Use a needle long enough to reach deep into the muscle. Infants age 6 through 11 mos: 1"; 1 through 2 yrs: 1–13"; children and adults 3 yrs and older: 1–1½".

2. With your left hand*, bunch up the muscle.

3. With your right hand*, insert the needle at a 90° angle to the skin with a quick thrust.

4. Push down on the plunger and inject the entire contents of the syringe. There is no need to aspi-rate.

5. Remove the needle and simultaneously apply pressure to the injection site with a dry cotton ball or gauze. Hold in place for several seconds.

6. If there is any bleeding, cover the injection site with a bandage.

7. Put the used syringe in a sharps container.

*Use the opposite hand if you are left-handed.

subcutaneous tissue

skin

90° angle

muscle

1. Gently shake the microinjection system before administering the vaccine.

2. Hold the system by placing the thumb and middle finger on the finger pads; the index finger should remain free.

3. Insert the needle perpendicular to the skin, in the region of the deltoid, in a short, quick movement.

4. Once the needle has been inserted, maintain light pressure on the surface of the skin and inject using the index finger to push on the plunger. Do not aspirate.

5. Remove the needle from the skin. With the needle directed away from you and others, push very firmly with the thumb on the plunger to activate the needle shield. You will hear a click when the shield extends to cover the needle.

6. Dispose of the applicator in a sharps con-tainer.



This policy and procedure shall remain in effect for all patients of the untilrescinded or until (date).

Medical Director’s signature: Effective date:

(name of practice or clinic)

Purpose: To reduce morbidity and mortality from influenza by vaccinating all children and adolescents who meet the criteria established by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices.

Policy: Under these standing orders, eligible nurses and other healthcare professionals (e.g., pharmacists), where allowed by state law, may vaccinate children and adolescents who meet any of the criteria below.

Procedure:1. Identify children and adolescents ages 6 months and older who have not completed their influenza vaccination(s) for the current influenza season.

2. Screen all patients for contraindications and precautions to influenza vaccine:

a. Contraindications: a serious systemic or anaphylactic reaction after ingesting eggs, after receiving a previous dose of influenza vaccine, or to an influenza vaccine component. For a list of vaccine components, go to www.cdc.gov/ vaccines/pubs/pinkbook/downloads/appendices/B/excipient-table-2.pdf. Do not give live attenuated influenza vaccine (LAIV; nasal spray) to people with a history of hypersensitivity to eggs, either anaphylactic or non-anaphylactic; pregnant adolescents; children younger than age 2 yrs; children age 2 through 4 yrs who have experienced wheezing or asthma within the past 12 mos, based on a healthcare provider’s statement; or children or adolescents with chronic pulmonary (including asthma), cardiovascular (excluding hypertension), renal, hepatic, neurologic/neuromuscular, hematologic, or metabolic (e.g., diabetes) disorders; immunosuppression, including that caused by medications or HIV; long-term aspirin therapy (applies to a child or adolescent age 6 mos through 18 yrs). b. Precautions: moderate or severe acute illness with or without fever; history of Guillain-Barré syndrome within 6 weeks of a previous influenza vaccination; for TIV only, allergic reaction to eggs consisting of hives only (observe patient for 30 minutes following vaccination); for LAIV only, close contact with an immunosuppressed person when the person requires protective isolation, receipt of influenza antivirals (e.g., amantadine, rimantadine, zanamivir, or oseltamivir) within the previous 48 hours or possibility of use within 14 days after vaccination

3. Provide all patients (or, in the case of a minor, their parent or legal representative) with a copy of the most current federal Vaccine Information Statement (VIS). You must document in the patient’s medical record or office log, the publication date of the VIS and the date it was given to the patient (parent/legal representative). Provide non-English speaking patients with a copy of the VIS in their native language, if available and preferred; these can be found at www.immunize.org/vis.

4. Administer injectable trivalent inactivated vaccine (TIV) intramuscularly in the vastus lateralis for infants (and toddlers lacking adequate deltoid mass) or in the deltoid muscle (for toddlers, children, and teens). Use a 22–25 g needle. Choose needle length appropriate to the child’s age and body mass: infants 6 through 11 mos: 1"; 1 through 2 yrs: 1–13"; 3yrs and older: 1–1½". Give 0.25 mL to children 6–35 mos and 0.5 mL for all others age 3 yrs and older. (Note: A e" needle may be used for patients weighing less that 130 lbs (<60kg) for injection in the deltoid muscle only if the skin is stretched tight, subcutaneous tissue is not bunched, and the injection is made at a 90-degree angle.) Alternatively, healthy children age 2 yrs and older may be given 0.2 mL of intranasal LAIV; 0.1 mL is sprayed into each nostril while the patient is in an upright position. Children age 6 mos through 8 yrs should receive a second dose 4 wks or more after the first dose if they are receiving influenza vaccine for the first time or if they did not receive at least 1 dose of vaccine in the 2010–2011 vaccination season.

5. Document each patient’s vaccine administration information and follow up in the following places: a. Medical chart: Record the date the vaccine was administered, the manufacturer and lot number, the vaccination site and route, and the name and title of the person administering the vaccine. If vaccine was not given, record the reason(s) for non-receipt of the vaccine (e.g., medical contraindication, patient refusal). b. Personal immunization record card: Record the date of vaccination and the name/location of the administering clinic.

6. Be prepared for management of a medical emergency related to the administration of vaccine by having a written emergency medical protocol available, as well as equipment and medications.

7. Report all adverse reactions to influenza vaccine to the federal Vaccine Adverse Event Reporting System (VAERS) at www.vaers.hhs.gov or (800) 822-7967. VAERS report forms are available at www.vaers.hhs.gov.

Standing Orders for Administering Influenza Vaccines to Children and Adolescents

www.immunize.org/catg.d/p3074a.pdf • Item #P3074a (8/11)


Technical content reviewed by the Centers for Disease Control and Prevention, August 2011.

Purpose: To reduce morbidity and mortality from influenza by vaccinating all adults who meet the criteria established by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices.

Policy: Under these standing orders, eligible nurses and other healthcare professionals (e.g., pharmacists), where allowed by state law, may vaccinate patients who meet any of the criteria below.

Procedure:1. Identify adults with no history of influenza vaccination for the current influenza season.

2. Screen all patients for contraindications and precautions to influenza vaccine: a. Contraindications: a serious systemic or anaphylactic reaction after ingesting eggs, after receiving a previous dose of influenza vaccine, or to an influenza vaccine component. For a list of vaccine components, go to www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/B/excipient-table-2.pdf. Do not give live attenuated influenza vaccine (LAIV; nasal spray) to an adult with a history of hypersensitivity to eggs, either anaphylatic or non-anaphylactic; who is pregnant, is age 50 years or older, or who has chronic pulmonary (including asthma), cardiovascular (excluding hypertension), renal, hepatic, neurologic/neuromuscular, hematologic, or metabolic (including diabetes) disorders; immunosuppression, including that caused by medications or HIV. b. Precautions: moderate or severe acute illness with or without fever; history of Guillain Barré syndrome within 6 weeks of a previous influenza vaccination; for TIV only, allergic reaction to eggs consisting of hives only (observe patient for at least 30 minutes following vaccination); for LAIV only, close contact with an immunosuppressed person when the person requires protective isolation, receipt of influenza antivirals (e.g., amantadine, rimantadine, zanamivir, or oseltamivir) within the previous 48 hours or possibility of use within 14 days after vaccination3. Provide all patients with a copy of the most current federal Vaccine Information Statement (VIS). You must document in the patient’s medical record or office log, the publication date of the VIS and the date it was given to the patient. Provide non-English speaking patients with a copy of the VIS in their native language, if available and preferred; these can be found at www.immunize.org/vis.

4. Administer influenza vaccine as follows: a) For adults of all ages, give 0.5 mL of injectable trivalent inactivated influenza vaccine (TIV-IM) intramuscularly (22–25g, 1–1½" needle) in the deltoid muscle. (Note: A e" needle may be used for adults weighing less than 130 lbs (<60 kg) for injection in the deltoid muscle only if the skin is stretched tight, subcutaneous tissue is not bunched, and the injection is made at a 90 degree angle; or b) For healthy adults younger than age 50 years, give 0.2 mL of intranasal LAIV; 0.1 mL is sprayed into each nostril while the patient is in an upright position; or c) For adults ages 18 through 64 years, give 0.1 ml TIV-ID intradermally by inserting the needle of the microinjection system at a 90 degree angle in the deltoid muscle; or d) For adults ages 65 years and older, give 0.5 mL of high-dose TIV-IM intramuscularly (22–25g, 1–1½" needle) in the deltoid muscle.

5. Document each patient’s vaccine administration information and follow up in the following places: a. Medical chart: Record the date the vaccine was administered, the manufacturer and lot number, the vaccination site and route, and the name and title of the person administering the vaccine. If vaccine was not given, record the reasons(s) for non-receipt of the vaccine (e.g., medical contraindication, patient refusal). b. Personal immunization record card: Record the date of vaccination and the name/location of the administering clinic.

6. Be prepared for management of a medical emergency related to the administration of vaccine by having a written emergency medical protocol available, as well as equipment and medications.


Standing Orders for Administering Influenza Vaccine to Adults




(name of practice or clinic)This policy and procedure shall remain in effect for all patients of the untilrescinded or until (date).


1. Is the person to be vaccinated sick today?

2. Does the person to be vaccinated have an allergy to eggs or

to a component of the vaccine?

3. Has the person to be vaccinated ever had a serious reaction to

influenza vaccine in the past?

4. Has the person to be vaccinated ever had Guillain-Barré syndrome?

www.immunize.org/catg.d/p4066.pdf • Item#P4066 (8/11)

For adult patients as well as parents of children to be vaccinated: The following questions will help us determine if there is any reason we should not give you or your child inactivated injectable influenza vaccination today. If you answer “yes” to any question, it does not necessarily mean you (or your child) should not be vaccinated. It just means additional questions must be asked. If a question is not clear, please ask your healthcare provider to explain it.

NoYesDon’t Know

Screening Questionnaire for Inactivated Injectable Influenza Vaccination

Form completed by: ____________________________________________ Date: ______________

Form reviewed by: _____________________________________________ Date: ______________



Patient name: Date of birth: (mo.) (day) (yr.)



2. Does the person to be vaccinated have an allergy to eggs or to a component of

the influenza vaccine?

3. Has the person to be vaccinated ever had a serious reaction to intranasal

influenza vaccine (FluMist) in the past?

4. Is the person to be vaccinated younger than age 2 years or older than age 49 years?

5. Does the person to be vaccinated have a long-term health problem with heart

disease, lung disease, asthma, kidney disease, neurologic or neuromuscular disease, liver disease, metabolic disease (e.g., diabetes), or anemia or another blood disorder? 6. If the person to be vaccinated is a child age 2 through 4 years, in the past 12 months, has a healthcare provider ever told you that he or she had wheezing or asthma?

7. Does the person to be vaccinated have a weakened immune system because of

HIV/AIDS or another disease that affects the immune system, long-term treatment with drugs such as high-dose steroids, or cancer treatment with radiation or drugs?

8. Is the person to be vaccinated receiving antiviral medications?

9. Is the child or teen to be vaccinated receiving aspirin therapy or aspirin-containing therapy?

10. Is the person to be vaccinated pregnant or could she become pregnant within

the next month?


12. Does the person to be vaccinated live with or expect to have close contact with a person whose immune system is severely compromised and who must be in

protective isolation (e.g., an isolation room of a bone marrow transplant unit)?

13. Has the person to be vaccinated received any other vaccinations in the past 4 weeks?


For adult patients as well as parents of children to be vaccinated: The following questions will help us determine if there is any reason we should not give you or your child live attenuated intranasal influenza vaccine (FluMist) today. If you answer “yes” to any question, it does not necessarily mean you (or your child) should not be vaccinated. It just means additional questions must be asked. If a question is not clear, please ask your healthcare provider to explain it. NoYes

Don’t Know

Screening Questionnaire for Live Attenuated Intranasal Influenza Vaccination

Form completed by: __________________________________________________ Date: _________________________

Form reviewed by: ___________________________________________________ Date: ________________________



Influenza Education Materials for Patients & StaffFree and CDC-reviewed, they’re ready for you to download, copy, and use!

First do no harm Protect patients by making sure all staff receive yearly influenza vaccine!The best way to prevent transmission of influenza to our patients is to mandate vaccination of healthcare workers. Leaders in medicine and infectious diseases have spoken: Mandatory influenza vaccina-tion for all healthcare workers is imperative! You can refer to the po-sition statements of these leading medical organizations to help you develop and implement a mandatory influenza vaccination policy at your healthcare institution or medical setting. Policy titles, URLs, publication dates, and excerpts follow.



American Academy of Family Physicians (AAFP) AAFP Mandatory Influenza Vaccination of Health Care Personnel (June 2011) www.aafp.org/online/en/home/clinical/immunizationres/influenza/mandatoryinfluenza.html“The AAFP supports annual mandatory influenza immunization for health care personnel (HCP) except for religious or medical reasons (not personal preferences). If HCP are not vaccinated, policies to adjust practice activi-ties during flu season are appropriate (e.g. wear masks, refrain from direct patient care).”

American Academy of Pediatrics (AAP) Policy Statement—Recommendation for Mandatory Influenza Immuniza-tion of All Health Care Personnel (October 1, 2010) http://pediatrics.aappublications.org/cgi/content/abstract/peds.2010-2376v1 “The implementation of mandatory annual influenza immunization pro-grams for HCP nationwide is long overdue. For the prevention and control of influenza, now is the time to put the health and safety of the patient first.”

American College of Physicians (ACP) ACP Policy on Influenza Vaccination of Health Care Workers (October 1, 2010) www.acponline.org/clinical_information/resources/adult_immunization/flu_hcw.pdf “Vaccinating HCWs against influenza represents a duty of care, and a stan-dard of quality care, so it should be reasonable that this duty should super-sede HCW personal preference.”

American Hospital Association (AHA) AHA Endorses Patient Safety Policies Requiring Influenza Vaccination of Health Care Workers (July 22, 2011) www.aha.org/advocacy-issues/tools-resources/advisory/2011/110722-quality-adv.pdf“To protect the lives and welfare of patients and employees, AHA supports mandatory patient safety policies that require either influenza vaccination or wearing a mask in the presence of patients across healthcare settings during flu season. The aim is to achieve the highest possible level of protection.”

American Medical Directors Association (AMDA) Mandatory Immunization for Long Term Care Workers (March 2011) www.amda.com/governance/resolutions/J11.cfm “Therefore be it resolved, AMDA - Dedicated to Long Term Care Medicine supports a mandatory annual influenza vaccination for every long-term health care worker who has direct patient contact unless a medical contra-indication or religious objection exists.”

American Pharmacists Association (APhA)Requiring Influenza Vaccination for All Pharmacy Personnel (April 2011)w w w . p h a r m a c i s t . c o m / A M / T e m p l a t e . c f m ? S e c t i o n = H o u s e _o f _ D e l e g a t e s & T E M P L A T E = / C M / C o n t e n t D i s p l a y .cfm&CONTENTID=25910“APhA supports an annual influenza vaccination as a condition of employ-ment, training, or volunteering, within an organization that provides phar-macy services or operates a pharmacy or pharmacy department (unless a valid medical or religious reason precludes vaccination).”

American Public Health Association (APHA)Annual Influenza Vaccination Requirements for Health Workers (November 9, 2010) www.apha.org/advocacy/policy/policysearch/default.htm?id=1410 “Encourages institutional, employer, and public health policy to require in-fluenza vaccination of all health workers as a precondition of employment and thereafter on an annual basis, unless a medical contraindication recog-nized in national guidelines is documented in the worker’s health record.”

Association for Professionals in Infection Control and Epidemiology (APIC) Influenza Vaccination Should Be a Condition of Employment for Health-care Personnel, Unless Medically Contraindicated (February 1, 2011) www.apic.org/Content/NavigationMenu/GovernmentAdvocacy/PublicPolicyLibrary/APIC_Influenza_Immunization_of_HCP_12711.PDF “As a profession that relies on evidence to guide our decisions and actions, we can no longer afford to ignore the compelling evidence that supports requir-ing influenza vaccine for HCP. This is not only a patient safety imperative, but is a moral and ethical obligation to those who place their trust in our care.”

Infectious Diseases Society of America (IDSA)IDSA Policy on Mandatory Immunization of Health Care Workers Against Seasonal and Pandemic Influenza (rev. July 28, 2010)www.idsociety.org/HCW_Policy “Physicians and other health care providers must have two special objectives in view when treating patients, namely, ‘to do good or to do no harm’ (Hippocratic Corpus in Epidemics: Bk. I, Sect. 5, trans. Adams), and have an ethical and mor-al obligation to prevent transmission of infectious diseases to their patients.”

Society for Healthcare Epidemiology of America (SHEA) Influenza Vaccination of Healthcare Personnel (rev. August 31, 2010)www.journals.uchicago.edu/doi/full/10.1086/656558 “SHEA views influenza vaccination of HCP as a core patient and HCP safe-ty practice with which noncompliance should not be tolerated.”

Visit Immunization Action

Coalition’s “Honor Roll

for Patient Safety” to view

stellar examples of influenza

vaccination mandates

in healthcare settings at

www.immunize.org/honor-roll

continued on page 2

Guides for determining the number of doses of influenza vaccine to give to children ages 6 months through 8 years during the 2011–12 influenza season

Immunization Action Coalition • 1573 Selby Avenue • St. Paul, MN 55104 • (651) 647-9009 • www.immunize.org • www.vaccineinformation.org

www.immunize.org/catg.d/p3093.pdf • Item #P3093 (9/11)Technical content reviewed by the Centers for Disease Control and Prevention, September 2011.

Give 2 doses of 2011-2012 influenza vaccine this season, spaced at least 4 weeks apart.

Number of doses the child age 6 mos through 8 yrs received in the 2010-11 season

Number of doses recommended for the 2011-12 season

None or unknown 2

1 or 2 1

Algorithm

Did the child age 6 mos through 8 yrs receive

1 or more doses of the 2010–2011 seasonal influenza vaccine?

Yes

No/Not Sure

Give 1 dose of 2011-2012 influenza vaccine this season.

Table

or

Declination of Influenza Vaccination

My employer or affiliated health facility, ___________________________, has recommended that I receive influenza vaccination to protect the patients I serve.

I acknowledge that I am aware of the following facts:

Influenza is a serious respiratory disease that kills thousands of people in the United States each year.

Influenza vaccination is recommended for me and all other healthcare workers to protect this facility’s patients from influenza, its complications, and death.

If I contract influenza, I can shed the virus for 24 hours before influenza symptoms appear. My shedding the virus can spread influenza to patients in this facility.

If I become infected with influenza, I can spread severe illness to others even when my symptoms are mild or non-existent.

I understand that the strains of virus that cause influenza infection change almost every year and, even if they don’t change, my immunity declines over time. This is why vaccination against influenza is recommended each year.

I understand that I cannot get influenza from the influenza vaccine.

The consequences of my refusing to be vaccinated could have life-threatening consequences to my health and the health of those with whom I have contact, including •allpatientsinthishealthcarefacility •mycoworkers •myfamily •mycommunity

Despite these facts, I am choosing to decline influenza vaccination right now for the following reasons: ____________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

I understand that I can change my mind at any time and accept influenza vaccination, if vaccine is still available.

I have read and fully understand the information on this declination form.

Signature: ____________________________________________ Date: ___________________

Name (print): _________________________________________

Department: __________________________________________




Reference: CDC. Prevention and Control of Influenza with Vaccines— Recommendations of ACIP at www.cdc.gov/flu/professionals/acip/index.htm

Any child or teen who shows the following emergency warning signs needs urgent medical attention – take them to an emergency room or call 9 -1-1.• Fast breathing or trouble breathing

• Bluish skin color

• Not waking up or not interacting

• Being so irritable that the child does not want to be held

• Not drinking enough fluids

• Not urinating or no tears when crying

• Severe or persistent vomiting

• Influenza-like symptoms improve but then return with fever andworse cough

Any adult who shows the following emergency warning signsneeds urgent medical attention – take them to an emergencyroom or call 9-1-1.• Difficulty breathing or shortness of breath

• Pain or pressure in the chest or abdomen

• Confusion

• Severe or persistent vomiting

• Sudden dizziness

• Influenza-like symptoms improve but then return with fever andworse cough

Seek emergency medical care if you or a family member shows the signsbelow – a life could be at risk!

Emergency warning signs for children or teens with influenza

Emergency warning signs for adults with influenza

It’s a fact – every year, people of all ages in theU.S. die from influenza and its complications.

Keep this handy! Post it on your refrigerator or another place where it will be easy to find!

Immunization Action Coalition 1573 Selby Avenue • St. Paul, MN 55104 • 651 647-9009 • www.vaccineinformation.org • www.immunize.org


copy this for your patients

Adapted from the Centers for Disease Control and PreventionTechnical content reviewed by the Centers for Disease Control and Prevention, August 2010.

Influenza usually comes on suddenly. Symptoms can include high fever,chills, headaches, exhaustion, sore throat, cough, and all-over body aches.Some people say, “It felt like a truck hit me!” Symptoms can also be mild.Regardless, when influenza strikes your family, the result is lost time fromwork and school.

An infected person can spread influenza when they cough, sneeze, or just talk near others. They can also spread it by touching or sneezing on an objectthat someone else touches later. And, an infected person doesn’t have to feelsick to be contagious: they can spread influenza to others when they feel well – before their symptoms have even begun.

Each year, more than 200,000 people are hospitalized in the U.S. frominfluenza and its complications. Between 3,000 and 50,000 die, which showshow unpredictable influenza can be. The people most likely to be hospitalizedand die are infants, young children, older adults, and people of all ages whohave conditions such as heart or lung disease. But remember, it’s not only theyoungest, oldest, or sickest who die: Every year influenza kills people who wereotherwise healthy.

There’s no substitute for yearly vaccination in protecting the people you lovefrom influenza. Either type of influenza vaccine (the “shot” or nasal spray) will help keep you and your loved ones safe from a potentially deadly disease. Get vaccinated every year, and make sure your children and your parents arevaccinated, too.

Influenza can make you, your children, or your parentsreally sick.

Influenza spreads easily fromperson to person.

Influenza and its complicationscan be so serious that they canput you, your children, or your parents in the hospital – or lead to death.

Influenza can be a very seriousdisease for you, your family, and friends – but you can all beprotected by getting vaccinated.

Get vaccinated every year! Get your children vaccinated! Be sure your parents get vaccinated, too!

copy this for your patients

Don’t take chances with your family’s health – make sure you all get vaccinated against influenza every year!

Here’s how influenza can hurt your family. . .

Immunization Action Coalition 1573 Selby Avenue • St. Paul, MN 55104 • 651 647-9009 • www.vaccineinformation.org • www.immunize.org


Technical content reviewed by the Centers for Disease Control and Prevention, November 2010.

INACTIVATEDINFLUENZAVACCINE

Why get vaccinated?1Infl uenza (“fl u”) is a contagious disease.

It is caused by the infl uenza virus, which can be spread by coughing, sneezing, or nasal secretions.

Anyone can get infl uenza, but rates of infection are highest among children. For most people, symptoms last only a few days. They include:• fever/chills • sore throat • muscle aches • fatigue• cough • headache • runny or stuffy nose

Other illnesses can have the same symptoms and are often mistaken for infl uenza.

Young children, people 65 and older, pregnant women, and people with certain health conditions – such as heart, lung or kidney disease, or a weakened immune system – can get much sicker. Flu can cause high fever and pneumonia, and make existing medical conditions worse. It can cause diarrhea and seizures in children. Each year thousands of people die from infl uenza and even more require hospitalization.

By getting fl u vaccine you can protect yourself from infl uenza and may also avoid spreading infl uenza to others.

Who should get inactivated infl uenza vaccine and when?3

There are two types of infl uenza vaccine:

1. Inactivated (killed) vaccine, the “fl u shot,” is given by injection with a needle.

2. Live, attenuated (weakened) infl uenza vaccine is sprayed into the nostrils. This vaccine is described in a separate Vaccine Information Statement.

A “high-dose” inactivated infl uenza vaccine is available for people 65 years of age and older. Ask your doctor for more information.

Infl uenza viruses are always changing, so annualvaccination is recommended. Each year scientists try to match the viruses in the vaccine to those most likely to cause fl u that year. Flu vaccine will not prevent disease from other viruses, including fl u viruses not contained in the vaccine.

It takes up to 2 weeks for protection to develop after the shot. Protection lasts about a year.

WHOAll people 6 months of age and older should get fl u vaccine.

Vaccination is especially important for people at higher risk of severe infl uenza and their close contacts, including healthcare personnel and close contacts of children younger than 6 months.

WHENGet the vaccine as soon as it is available. This should provide protection if the fl u season comes early. You can get the vaccine as long as illness is occurring in your community.

Infl uenza can occur at any time, but most infl uenza occurs from October through May. In recent seasons, most infections have occurred in January and February. Getting vaccinated in December, or even later, will still be benefi cial in most years.

Adults and older children need one dose of infl uenza vaccine each year. But some children younger than 9 years of age need two doses to be protected. Ask your doctor.

Infl uenza vaccine may be given at the same time as other vaccines, including pneumococcal vaccine.

Many Vaccine Information Statements are available in Spanish and other languages. See www.immunize.org/visHojas de Informacián Sobre Vacunas están disponibles en español y en muchos otros idiomas. Visite www.immunize.org/vis

2011-12W H A T Y O U N E E D T O K N O W

Inactivated infl uenza vaccine2

Some inactivated infl uenza vaccine contains a preservative called thimerosal. Thimerosal-free infl uenza vaccine is available. Ask your doctor for more information.

Some people should not get inactivated infl uenza vaccine or should wait

4

• Tell your doctor if you have any severe (life-threatening) allergies, including a severe allergy to eggs. A severe allergy to any vaccine component may be a reason not to get the vaccine. Allergic reactions to infl uenza vaccine are rare.

• Tell your doctor if you ever had a severe reaction after a dose of infl uenza vaccine.

• Tell your doctor if you ever had Guillain-Barré

LIVE, INTRANASAL INFLUENZAVACCINE

Why get vaccinated?1Infl uenza (“fl u”) is a contagious disease.

It is caused by the infl uenza virus, which can be spread by coughing, sneezing, or nasal secretions.

Anyone can get infl uenza, but rates of infection are highest among children. For most people, symptoms last only a few days. They include:

• fever/chills • sore throat • muscle aches • fatigue• cough • headache • runny or stuffy nose

Other illnesses can have the same symptoms and are often mistaken for infl uenza.

Young children, people 65 and older, pregnant women, and people with certain health conditions – such as heart, lung or kidney disease, or a weakened immune system – can get much sicker. Flu can cause high fever and pneumonia, and make existing medical conditions worse. It can cause diarrhea and seizures in children. Each year thousands of people die from infl uenza and even more require hospitalization.

By getting fl u vaccine you can protect yourself from infl uenza and may also avoid spreading infl uenza to others.

There are two types of infl uenza vaccine:

1. Live, attenuated infl uenza vaccine (LAIV) contains live but attenuated (weakened) infl uenza virus. It is sprayed into the nostrils.

2. Inactivated (killed) infl uenza vaccine, the “fl u shot,” is given by injection with a needle. This vaccine is described in a separate Vaccine Information Statement.

Infl uenza viruses are always changing, so annual vaccination is recommended. Each year scientists try to match the viruses in the vaccine to those most likely to cause fl u that year. Flu vaccine will not prevent disease from other viruses, including fl u viruses not contained in the vaccine.

It takes up to 2 weeks for protection to develop after the vaccination. Protection lasts about a year.

LAIV does not contain thimerosal or other preservatives.

LAIV is recommended for healthy people 2 through 49 years of age, who are not pregnant and do not have certain health conditions (see #4, below).

Vaccine Information Statements are available in Spanish and many other languages. See www.immunize.org/visHojas de Informacián Sobre Vacunas están disponibles en español y en muchos otros idiomas. Visite www.immunize.org/vis

2011-12W H A T Y O U N E E D T O K N O W

Live, attenuated infl uenza vaccine - LAIV (nasal spray)2

Who can receive LAIV?3

LAIV is not recommended for everyone. The following people should get the inactivated vaccine (fl u shot) instead:

• Adults 50 years of age and older or children from 6 through 23 months of age. (Children younger than 6 months should not get either infl uenza vaccine.)

Children younger than 5 years with asthma or one or more •episodes of wheezing within the past year.

Pregnant women. •

People who have long-term health problems with:•heart disease - kidney or liver disease-lung disease - metabolic disease, such as diabetes-asthma - anemia, and other blood disorders-

Anyone with certain muscle or nerve disorders (such •as seizure disorders or cerebral palsy) that can lead to breathing or swallowing problems.

Anyone with a weakened immune system.•

Anyone in close contact with someone whose immune •system is so weak they require care in a protected environment (such as a bone marrow transplant unit). Closecontacts of other people with a weakened immune system (such as those with HIV) may receive LAIV. Healthcare personnel in neonatal intensive care units or oncology clinics may receive LAIV.

Children or adolescents on long-term aspirin treatment.•

Tell your doctor if you have any severe (life-threatening) allergies, including a severe allergy to eggs. A severe allergy to any vaccine component may be a reason not to get the vaccine. Allergic reactions to infl uenza vaccine are rare.

Tell your doctor if you ever had a severe reaction after a dose of infl uenza vaccine.

Tell your doctor if you ever had Guillain-Barré Syndrome (a severe paralytic illness, also called GBS). Your doctor will help you decide whether the vaccine is recommended for you.

Some people should not receive LAIV4

Manufacturer Trade Name How SuppliedMercury Content (µg Hg/0.5mL)

Age Group Product Code1

CSL Biotherapies Afluria (TIV)2

0.5 mL (single-dose syringe) 09 years & older3

90656

5.0 mL (multi-dose vial) 24.590658Q2035 (Medicare)

GlaxoSmithKline Fluarix (TIV) 0.5 mL (single-dose syringe) 0 3 years & older 90656

ID Biomedical Corp of Quebec, a subsidiary of GlaxoSmithKline

FluLaval (TIV) 5.0 mL (multi-dose vial) 25 18 years & older90658 Q2036 (Medicare)

MedImmune FluMist (LAIV)2 0.2 mL (single-use nasal spray) 0 2 through 49 years 90660

Novartis Vaccines Fluvirin (TIV) 0.5 mL (single-dose syringe) <14 years & older

90656

5.0 mL (multi-dose vial) 2590658 Q2037 (Medicare)

sanofi pasteur Fluzone (TIV) 0.25 mL (single-dose syringe) 0 6 through 35 months 90655

5.0 mL (multi-dose vial) 25 6 through 35 months 90657

0.5 mL (single-dose syringe) 0 3 years & older 90656

0.5 mL (single-dose vial) 0 3 years & older 90656

5.0 mL (multi-dose vial) 25 3 years & older90658 Q2038 (Medicare)

Fluzone High-Dose (TIV) 0.5 mL (single-dose syringe) 0 65 years & older 90662

Fluzone Intradermal (TIV)0.1 mL (single-dose microinjec-tion system)

0 18 through 64 years 90654

Influenza Vaccine Products for the 2011–12 Influenza Season

Information about influenza vaccine products

Technical content reviewed by the Centers for Disease Control and Prevention, August 2011. www.immunize.org/catg.d/p4072.pdf • Item #P4072 (8/11)

1. Effective for claims with dates of service on or after 1/1/2011, CPT code 90658 is no longer payable for Medicare; rather, HCPCS Q codes (as indicated above) should be submitted for Medicare payment purposes.

2. TIV is the abbreviation for trivalent inactivated influenza vaccine (injectable); LAIV is the abbreviation for live attenuated influenza vaccine (nasal spray).

3. On August 6, 2010, ACIP recommended that Afluria not be used in children younger than age 9 years. If no other age-appropriate TIV is available, Afluria may be considered for a child age 5 through 8 years at high risk for influenza complications, after risks and benefits have been discussed with the parent or guardian. Afluria should not be used in children younger than age 5 years. This recommendation continues for the 2011–2012 influenza season.


(Page 1 of 2)

For 8-1/2" x 11" copies of the pieces above, visit IAC's website: www.immunize.org1. Standing orders for administering influenza vaccines to children & adolescents: www.immunize.org/catg.d/p3074a.pdf 2. Standing orders for administering influenza vaccine to adults: www.immunize.org/catg.d/p3074.pdf 3. Screening questionnaire for inactivated injectable influenza vaccination: www.immunize.org/catg.d/p4066.pdf4. Screening questionnaire for live attenuated intranasal influenza vaccination: www.immunize.org/catg.d/p4067.pdf 5. First do no harm: Protect patients by making sure all staff receive yearly influenza vaccine! www.immunize.org/catg.d/p2014.pdf6. Declination of influenza vaccination (for healthcare worker refusal): www.immunize.org/catg.d/p4068.pdf7. Influenza vaccine products for the 2011–12 influenza season: www.immunize.org/catg.d/p4072.pdf 8. Seek emergency medical care if you or a family member shows the signs below: www.immunize.org/catg.d/p4073.pdf9. Don’t take chances with your family’s health—make sure you all get vaccinated against influenza! www.immunize.org/catg.d/p4069.pdf10. Federally required Vaccine Information Statements in English and other languages: www.immunize.org/vis - Inactivated Influenza Vaccine: What you need to know: www.immunize.org/vis/flu_inactive.pdf - Live, Intranasal Influenza Vaccine: What you need to know: www.immunize.org/vis/flu_live.pdf11. Guides for determining number of doses of influenza vaccine for children 6 months through 8 years: www.immunize.org/catg.d/p3093.pdf












http://www.immunize.org/vis/flu_inactive.pdf

http://www.immunize.org/vis/flu_live.pdf












http://www.immunize.org/vis/flu_inactive.pdf

http://www.immunize.org/vis/flu_live.pdf



This policy and procedure shall remain in effect for all patients of the untilrescinded or until (date).


(name of practice or clinic)

Purpose: To reduce morbidity and mortality from influenza by vaccinating all children and adolescents who meet the criteria established by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices.

Policy: Under these standing orders, eligible nurses and other healthcare professionals (e.g., pharmacists), where allowed by state law, may vaccinate children and adolescents who meet any of the criteria below.

Procedure:1. Identify children and adolescents ages 6 months and older who have not completed their influenza vaccination(s) for the current influenza season.

2. Screen all patients for contraindications and precautions to influenza vaccine:

a. Contraindications: a serious systemic or anaphylactic reaction after ingesting eggs, after receiving a previous dose of influenza vaccine, or to an influenza vaccine component. For a list of vaccine components, go to www.cdc.gov/ vaccines/pubs/pinkbook/downloads/appendices/B/excipient-table-2.pdf. Do not give live attenuated influenza vaccine (LAIV; nasal spray) to people with a history of hypersensitivity to eggs, either anaphylactic or non-anaphylactic; pregnant adolescents; children younger than age 2 yrs; children age 2 through 4 yrs who have experienced wheezing or asthma within the past 12 mos, based on a healthcare provider’s statement; or children or adolescents with chronic pulmonary (including asthma), cardiovascular (excluding hypertension), renal, hepatic, neurologic/neuromuscular, hematologic, or metabolic (e.g., diabetes) disorders; immunosuppression, including that caused by medications or HIV; long-term aspirin therapy (applies to a child or adolescent age 6 mos through 18 yrs). b. Precautions: moderate or severe acute illness with or without fever; history of Guillain-Barré syndrome within 6 weeks of a previous influenza vaccination; for TIV only, allergic reaction to eggs consisting of hives only (observe patient for 30 minutes following vaccination); for LAIV only, close contact with an immunosuppressed person when the person requires protective isolation, receipt of influenza antivirals (e.g., amantadine, rimantadine, zanamivir, or oseltamivir) within the previous 48 hours or possibility of use within 14 days after vaccination

3. Provide all patients (or, in the case of a minor, their parent or legal representative) with a copy of the most current federal Vaccine Information Statement (VIS). You must document in the patient’s medical record or office log, the publication date of the VIS and the date it was given to the patient (parent/legal representative). Provide non-English speaking patients with a copy of the VIS in their native language, if available and preferred; these can be found at www.immunize.org/vis.

4. Administer injectable trivalent inactivated vaccine (TIV) intramuscularly in the vastus lateralis for infants (and toddlers lacking adequate deltoid mass) or in the deltoid muscle (for toddlers, children, and teens). Use a 22–25 g needle. Choose needle length appropriate to the child’s age and body mass: infants 6 through 11 mos: 1"; 1 through 2 yrs: 1–13"; 3yrs and older: 1–1½". Give 0.25 mL to children 6–35 mos and 0.5 mL for all others age 3 yrs and older. (Note: A e" needle may be used for patients weighing less that 130 lbs (<60kg) for injection in the deltoid muscle only if the skin is stretched tight, subcutaneous tissue is not bunched, and the injection is made at a 90-degree angle.) Alternatively, healthy children age 2 yrs and older may be given 0.2 mL of intranasal LAIV; 0.1 mL is sprayed into each nostril while the patient is in an upright position. Children age 6 mos through 8 yrs should receive a second dose 4 wks or more after the first dose if they are receiving influenza vaccine for the first time or if they did not receive at least 1 dose of vaccine in the 2010–2011 vaccination season.

5. Document each patient’s vaccine administration information and follow up in the following places: a. Medical chart: Record the date the vaccine was administered, the manufacturer and lot number, the vaccination site and route, and the name and title of the person administering the vaccine. If vaccine was not given, record the reason(s) for non-receipt of the vaccine (e.g., medical contraindication, patient refusal). b. Personal immunization record card: Record the date of vaccination and the name/location of the administering clinic.

6. Be prepared for management of a medical emergency related to the administration of vaccine by having a written emergency medical protocol available, as well as equipment and medications.


Standing Orders for Administering Influenza Vaccines to Children and Adolescents

www.immunize.org/catg.d/p3074a.pdf • Item #P3074a (8/11)



Standing Orders for Administering Influenza VaccinesThese documents are ready for you to download, copy, and use!

Download these influenza standing orders and use them “as is” or modify them to suit your work setting.

Additional sets of standing orders for all routinely recommended vaccines are available at www.immunize.org/standing-orders

Influenza vaccination standing orders for adults: www.immunize.org/catg.d/p3074.pdf Influenza vaccination standing orders for children: www.immunize.org/catg.d/p3074a.pdf

Purpose: To reduce morbidity and mortality from influenza by vaccinating all adults who meet the criteria established by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices.

Policy: Under these standing orders, eligible nurses and other healthcare professionals (e.g., pharmacists), where allowed by state law, may vaccinate patients who meet any of the criteria below.

Procedure:1. Identify adults with no history of influenza vaccination for the current influenza season.

2. Screen all patients for contraindications and precautions to influenza vaccine: a. Contraindications: a serious systemic or anaphylactic reaction after ingesting eggs, after receiving a previous dose of influenza vaccine, or to an influenza vaccine component. For a list of vaccine components, go to www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/B/excipient-table-2.pdf. Do not give live attenuated influenza vaccine (LAIV; nasal spray) to an adult with a history of hypersensitivity to eggs, either anaphylatic or non-anaphylactic; who is pregnant, is age 50 years or older, or who has chronic pulmonary (including asthma), cardiovascular (excluding hypertension), renal, hepatic, neurologic/neuromuscular, hematologic, or metabolic (including diabetes) disorders; immunosuppression, including that caused by medications or HIV. b. Precautions: moderate or severe acute illness with or without fever; history of Guillain Barré syndrome within 6 weeks of a previous influenza vaccination; for TIV only, allergic reaction to eggs consisting of hives only (observe patient for at least 30 minutes following vaccination); for LAIV only, close contact with an immunosuppressed person when the person requires protective isolation, receipt of influenza antivirals (e.g., amantadine, rimantadine, zanamivir, or oseltamivir) within the previous 48 hours or possibility of use within 14 days after vaccination3. Provide all patients with a copy of the most current federal Vaccine Information Statement (VIS). You must document in the patient’s medical record or office log, the publication date of the VIS and the date it was given to the patient. Provide non-English speaking patients with a copy of the VIS in their native language, if available and preferred; these can be found at www.immunize.org/vis.

4. Administer influenza vaccine as follows: a) For adults of all ages, give 0.5 mL of injectable trivalent inactivated influenza vaccine (TIV-IM) intramuscularly (22–25g, 1–1½" needle) in the deltoid muscle. (Note: A e" needle may be used for adults weighing less than 130 lbs (<60 kg) for injection in the deltoid muscle only if the skin is stretched tight, subcutaneous tissue is not bunched, and the injection is made at a 90 degree angle; or b) For healthy adults younger than age 50 years, give 0.2 mL of intranasal LAIV; 0.1 mL is sprayed into each nostril while the patient is in an upright position; or c) For adults ages 18 through 64 years, give 0.1 ml TIV-ID intradermally by inserting the needle of the microinjection system at a 90 degree angle in the deltoid muscle; or d) For adults ages 65 years and older, give 0.5 mL of high-dose TIV-IM intramuscularly (22–25g, 1–1½" needle) in the deltoid muscle.

5. Document each patient’s vaccine administration information and follow up in the following places: a. Medical chart: Record the date the vaccine was administered, the manufacturer and lot number, the vaccination site and route, and the name and title of the person administering the vaccine. If vaccine was not given, record the reasons(s) for non-receipt of the vaccine (e.g., medical contraindication, patient refusal). b. Personal immunization record card: Record the date of vaccination and the name/location of the administering clinic.

6. Be prepared for management of a medical emergency related to the administration of vaccine by having a written emergency medical protocol available, as well as equipment and medications.


Standing Orders for Administering Influenza Vaccine to Adults




(name of practice or clinic)This policy and procedure shall remain in effect for all patients of the untilrescinded or until (date).





http://www.immunize.org/standing-orders




12


2. Does the person to be vaccinated have an allergy to eggs or

to a component of the vaccine?

3. Has the person to be vaccinated ever had a serious reaction to

influenza vaccine in the past?



For adult patients as well as parents of children to be vaccinated: The following questions will help us determine if there is any reason we should not give you or your child inactivated injectable influenza vaccination today. If you answer “yes” to any question, it does not necessarily mean you (or your child) should not be vaccinated. It just means additional questions must be asked. If a question is not clear, please ask your healthcare provider to explain it.

NoYesDon’t Know

Screening Questionnaire for Inactivated Injectable Influenza Vaccination

Form completed by: ____________________________________________ Date: ______________

Form reviewed by: _____________________________________________ Date: ______________




13Immunization Action Coalition • 1573 Selby Ave. • St. Paul, MN 55104 • (651) 647-9009 • www.immunize.org • www.vaccineinformation.org


2. Does the person to be vaccinated have an allergy to eggs or to a component of

the influenza vaccine?

3. Has the person to be vaccinated ever had a serious reaction to intranasal

influenza vaccine (FluMist) in the past?

4. Is the person to be vaccinated younger than age 2 years or older than age 49 years?

5. Does the person to be vaccinated have a long-term health problem with heart

disease, lung disease, asthma, kidney disease, neurologic or neuromuscular disease, liver disease, metabolic disease (e.g., diabetes), or anemia or another blood disorder? 6. If the person to be vaccinated is a child age 2 through 4 years, in the past 12 months, has a healthcare provider ever told you that he or she had wheezing or asthma?

7. Does the person to be vaccinated have a weakened immune system because of

HIV/AIDS or another disease that affects the immune system, long-term treatment with drugs such as high-dose steroids, or cancer treatment with radiation or drugs?

8. Is the person to be vaccinated receiving antiviral medications?

9. Is the child or teen to be vaccinated receiving aspirin therapy or aspirin-containing therapy?

10. Is the person to be vaccinated pregnant or could she become pregnant within

the next month?


12. Does the person to be vaccinated live with or expect to have close contact with a person whose immune system is severely compromised and who must be in

protective isolation (e.g., an isolation room of a bone marrow transplant unit)?

13. Has the person to be vaccinated received any other vaccinations in the past 4 weeks?


For adult patients as well as parents of children to be vaccinated: The following questions will help us determine if there is any reason we should not give you or your child live attenuated intranasal influenza vaccine (FluMist) today. If you answer “yes” to any question, it does not necessarily mean you (or your child) should not be vaccinated. It just means additional questions must be asked. If a question is not clear, please ask your healthcare provider to explain it. NoYes

Don’t Know

Screening Questionnaire for Live Attenuated Intranasal Influenza Vaccination

Form completed by: __________________________________________________ Date: _________________________

Form reviewed by: ___________________________________________________ Date: ________________________




unlikelytohaveaneggallergy.Don’trelyontheirabilitytoeateggsinbakedproducts(e.g.,cakes,cookies),however,sincethebakingmightdenaturetheproteinandmaskanintrinsicanaphylactical-lergytoeggs.

With Boostrix (Tdap, GSK) now licensed for use in people age 65 years and older, should we stop using Adacel (Tdap, sanofi pasteur) for this age group and use only Boostrix?No.CDCallowsuseofeitherproductforpeopleage65yearsandolder.

We have a local provider who gives immuniza-tions in the buttocks. This isn’t the preferred anatomic site for any age, is it?No,itisn’t.SuchinformationiscoveredinACIP’sGeneral Recommendations on Immunization:www.cdc.gov/mmwr/pdf/rr/rr6002.pdf (pages13–16).HelpfulrelatedhandoutsfromIAC•HowtoAdministerIMandSCInjections:www.immunize.org/catg.d/p2020.pdf

•How to Administer IM and SC Injections toAdults:www.immunize.org/catg.d/p2020A.pdf

Healthcare personnel issuesWhich vaccines does ACIP specifically recom-mend that healthcare personnel (HCP) receive in order to work in a healthcare setting? ACIP recommends that allHCPbe vaccinatedwith2dosesofMMRvaccine(orhaveevidenceofmeasles,mumps,andrubellaimmunity),annualinfluenzavaccination,1doseofTdap(especiallytoprotectagainstpertussis),3dosesofhepatitisBvaccineforthosewhomightbeexposedtobloodorbodyfluidsatwork,and2dosesofvaricellavaccine(orhaveevidenceofvaricellaimmunity).Fordefinitionsofevidenceofimmunitytomumpsmeasles, rubella, and varicella, please refer towww.cdc.gov/vaccines/recs/provisional/down-loads/mmr-evidence-immunity-Aug2009-508.pdf (forMMR)andwww.cdc.gov/mmwr/pdf/rr/rr5604.pdf(page26,forvaricella).

For which workers in healthcare settings does the Occupational Safety and Health Adminis-

tration (OSHA) require that hepatitis B vaccine be provided?OSHArequiresthathepatitisBvaccinebeprovidedfreeofchargetoHCPwhohavereasonablyantici-patedcontactwithbloodorbodyfluidsonthejob.ThisrequirementdoesnotincludeHCPwhowouldnotbeexpectedtohaveoccupationalrisk,suchasbillingstaffandgeneralofficeworkers.EmployersmustensurethatworkerswhodeclinehepatitisBvaccinationsignadeclinationform.ForafactsheetaboutthisOSHArequirement,gotowww.osha.gov/OshDoc/data_BloodborneFacts/bbfact05.pdf.

If an employee has 2 documented doses of MMR but has negative or equivocal titers for 1 or more of the antigens, what should we do? Same question if an employee has 2 docu-mented doses of varicella vaccine but tests negative.Actually,ACIPdoesnot recommend testing forimmunityinsuchsituations.Formeasles,mumps,andrubella,ACIPconsiders2documenteddosesofMMRvaccinegivenonorafterage1yearandatleast28daysaparttobeevidenceofimmunityforHCP.Forvaricella,ACIPconsiders2documenteddosesofvaccinetobeevidenceofimmunityforHCPas long as doses are givenno earlier thanage12months,with at least 3months between

dosesforchildrenyoungerthanage13years,oratleast4weeksbetweendosesforpeopleage13yearsandolder.Becauseofthelimitationsofserologictesting,

testsforevenproperlyvaccinatedindividualswilloftencomebackasnegativeorequivocal,puttingtheemployeehealthserviceinthedifficultpositionofhaving todosomething (e.g.,giveadditionaldoses,performafollow-uptiter).Ifahealthcareworkerdoesnothaveanydocu-

menteddosesofMMRand/orvaricellavaccine,heorshecan(1)betestedforimmunityor(2)justbegiven2dosesofMMRand/orvaricellaatleast4weeksapart.ACIPdoesnotrecommendserologictestingaftervaccination.Formoreinformationonthistopic,goto•IAC’s“AsktheExperts”websectiononMMRvaccination www.immunize.org/askexperts/ex-perts_mmr.asp

•IAC’s“AsktheExperts”websectiononvaricellavaccination www.immunize.org/askexperts/experts_var.asp.

•ACIP recommendations on the prevention ofmeasles, mumps, and rubella www.cdc.gov/mmwr/PDF/rr/rr4708.pdf(pages18–20)

•ACIP recommendations on the preventionofvaricellawww.cdc.gov/mmwr/pdf/rr/rr5604.pdf(page26)

How soon after a dose of Td can HCP receive a dose of Tdap?IftheyhavenotpreviouslyreceivedTdap,HCPinhospital,long-termcare,andambulatorycareset-tingsshouldreceiveasingledoseofTdapassoonasfeasibleandwithoutregardtothedosingintervalsincethelastTddose.NominimumintervalexistsbetweenreceivingTdandTdap.

Can Tdap be administered to pregnant HCP? In June 2011, after studying new safety andefficacy data,ACIP voted to recommend thatpregnantwomenwho have never received the

Ask the Experts . . . continued from page 1

IAC’s“Ask theExperts”

teamfromCDC

Andrew T. Kroger, MD, MPH Donna L. Weaver, RN, MN William L. Atkinson, MD, MPH

To receive “Ask the Experts” Q&As by email, subscribe to the Immunization Action Coalition’s

news service, IAC Express. Special “Ask the Experts” issues are published five times per year.

Subscribe at: www.immunize.org/subscribe

To find more than a thousand “Ask the Experts” Q&As answered by CDC experts, go to

www.immunize.org/askexperts

(continued on page 16)



http://www.cdc.gov/mmwr/pdf/rr/rr6002.pdf



http://www.immunize.org/catg.d/p2020A.pdf

http://www.cdc.gov/vaccines/recs/provisional/downloads/mmr-evidence-immunity-Aug2009-508.pdf





http://www.osha.gov/OshDoc/data_BloodborneFacts/bbfact05.pdf

http://www.osha.gov/OshDoc/data_BloodborneFacts/bbfact05.pdf

http://www.immunize.org/askexperts/experts_mmr.asp

http://www.immunize.org/askexperts/experts_mmr.asp

http://www.immunize.org/askexperts/experts_var.asp

http://www.immunize.org/askexperts/experts_var.asp

http://www.cdc.gov/mmwr/PDF/rr/rr4708.pdf

http://www.cdc.gov/mmwr/PDF/rr/rr4708.pdf




http://www.immunize.org/askexperts


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FREE with a contribution of $75 or more (see below). The CD contains all of IAC’s ready-to-print materials in English and any translations available in Spanish. Includes VISs in English and Spanish.

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Patient Immunization Record Cards — for children & teens, for adults, and for a lifetime!

(all are wallet-sized; details p. 3; call for discounts on bulk orders) 250 cards/box; 1 box–$45; 2 boxes–$40 each; 3 boxes–$37.50 each; 4 boxes–$34.50 each____ R2003 Child/teen immunization record cards ................................................ $ ___________ R2005 Adult immunization record cards ........................................................ $ ___________ R2004 Lifetime immunization record cards .................................................... $ _______

DVD: Immunization Techniques: Best Practices with Infants, Children, and Adults

(details p. 3; call for discounts on bulk orders) 1-9 copies–$17 each; 10-24 copies–$10.25 each; 25-49 copies–$7 each ____ D2021 Immunization Techniques: Best Practices with Children/Teens/Adults .... $ _______

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I’m contributing $75 or more and would like the additional thank-you gift of a CD containing all of IAC’s English- and Spanish-language print materials, plus Vaccine Information Statements in English and Spanish.

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Order Essential Immunization Resources from IACImmunization record cards for all: for adults, for children & teens, for a lifetime!Newin2010fromtheCaliforniaDepartmentofPublicHealth’sIm-munizationBranch,this25-minuteDVDhelpsensurethatstaffad-ministervaccinescorrectlytoallagegroups.Anexcellenttrainingtool,theDVDprovidesdetailedinformationonthesemajortopics:•Preparingvaccines—Mixing, reconstituting, anddrawingupavarietyofvaccineproductsandpreparations

•Administeringvaccines—Identifyingcorrectneedlelengths,in-

sertionangles,andinjectionsites,andgivinginjectable,oral,andnasal-sprayvaccines.

•Communicatingwithparentsandpatients—ProvidingVISs,an-sweringquestions,andobservingpatientsaftervaccination

ToorderthenewDVDoranyofourotheressentialimmunizationresources,printoutandmailor fax theformbeloworplaceyourorderonlineatwww.immunize.org/shop.




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Ask the Experts . . . continued from page 14

Vaccinate Adults correction policyIfyoufindanerror,pleasenotifyusimmediatelybysendinganemailmessagetoadmin@immunize.org.Wepublishnotificationofsignificanterrorsinouremail announcement service, IAC Express.Besureyou’resignedupforthisservice.Tosubscribe,visitwww.immunize.org/subscribe.

LaurelWood,MPA, re-cently joined the Immu-nizationActionCoalition(IAC)ascoordinatorforpublichealth.Laurelhasworked in a variety ofpublic health communi-cabledisease/epidemiol-ogyprogramsforalmostthirtyyears.Sherecentlyretiredafterservingforsixteenyearsastheim-munization programmanager for theAlaskaDepartmentofHealthandSocialServices.InthatroleLaurelprovidedoverallmanagementandoversightformultipleprogramactivities,includingdistributionofvaccinesfromacen-tralizeddepottopublicandprivateprovidersthroughout the state, development of a stateimmunization information system (IIS), andcoordinationofsitevisitswithVFCprovidersandschool/childcarefacilities.Laurelistheau-thorofmorethaneightyimmunizationarticlespublishedintheState of Alaska Epidemiology Bulletin,andformanyyearssheprovidedim-munizationtrainingforstudentsinthenursing/nursepractitionerprogramsattheUniversityofAlaskaAnchorage.Laurelwastherecipientofthe2007Natalie

J.Smith,M.D.Award,presentedbytheAsso-ciationof ImmunizationManagers (AIM)“inrecognitionofherhighlevelofinitiative,cre-ativityandcommitmenttoachievingvaccine-preventablediseasegoals,herserviceasarolemodelforimmunizationprogrammanagers,andhersignificantcontributionstotheadvancementofthemissionoftheAssociationofImmuniza-tionManagers.”PriortomovingtoAlaska,Laurelservedfor

fourteenyearsinavarietyofroleswiththeTen-nesseeDepartmentofHealth,includingsectionchief of Communicable and EnvironmentalDiseaseServicesanddirectoroftheAIDS/HIVProgram.LaurelhelpedfoundtheAssociationofImmu-

nizationManagers,servinginleadershipcapaci-tiesorasamemberoftheorganization’sExecu-tiveCommitteefrom1999–2011.In1999,shebecameAIM’soriginalchair,andsheassumedtheroleofchairagainin2009.SherepresentedAIMonseveralnationalcommitteesandservedastheleadoftheGuidelinesforVaccineStorageandHandlingEquipmentSubgroupofCDC’sInternationalVaccineStabilityWorkgroup.Laurel’sphotographhasbeenaddedtoIAC’s

staff page at www.immunize.org/aboutus/iacstaff.asp.

IAC Welcomes Laurel Wood as Coordinator for Public Health

Laurel Wood, MPA

Tdap vaccine be vaccinatedwith Tdap duringtheir third trimester or the second half of theirsecond trimester (after 20weeks gestation) tooptimizetheconcentrationofmaternalantibodiestransferred to the fetus.ACIPmade this recom-mendationinresponsetothecontinuingpertussisoutbreak,with the goal of protecting newbornswithmaternalantibodiesanddecreasingtheriskoftransmissionfrommothertoinfantafterbirth.If the vaccine is not administered during preg-nancy, it should be administered immediatelypostpartum.OnOctober 21, 2011,CDC issuedrecommendations for use of Tdap in pregnantwomen.To obtain the recommendations, go topages1424–1426ofthisdocument:www.cdc.gov/mmwr/pdf/wk/mm6041.pdf.

Can pregnant healthcare personnel administer live-virus vaccines? Apregnantstaffmembercanadministeranyvac-cineexceptsmallpoxvaccine.

Why is it so important to vaccinate HCP against influenza? BecauseHCPfrequentlyprovidecaretopatientsathighriskforcomplicationsofinfluenza,achievinghighratesofvaccinationamongHCPwillreducediseaseburdenandhealthcarecosts.Influenzaisreadilytransmittedfor24hoursbe-

foreapersondevelopsinfluenzasymptoms.Thatmeanssymptom-freeunvaccinatedHCPcantrans-mitinfluenzavirustopatientsbeforedevelopingsymptomsandelectingtostayhomeasawaytopreventtransmission.

Why does CDC recommend that we consider obtaining a signed declination from HCP who refuse influenza vaccination?Some studies have shown an increase inHCPinfluenzavaccineacceptancewhendeclinersarerequired to sign such a statement. In addition,suchstatementscanhelpavaccinationprogramassessthereasonsfordeclinationandplanfutureeducationalefforts.HereisalinktoIAC’ssampleinfluenzavaccina-

tiondeclinationform:www.immunize.org/catg.d/p4068.pdf.

Please tell me which professional associations have endorsed mandatory influenza vaccina-tion for HCP and have created policy state-ments to that effect.Thefollowingprofessionalassociationshave is-suedpolicystatementssupportingmandatoryHCPinfluenzavaccination:•American Academy of Family Physicianswww.aafp.org/online/en/home/cl inical /immunizationres/influenza/mandatoryinfluenza.html

•AmericanAcademyofPediatricshttp://pediatrics.aappublications.org/content/early/2010/09/13/peds.2010-2376.abstract

•AmericanCollegeofPhysicianswww.acponline.org/clinical_information/resources/adult_immunization/flu_hcw.pdf

•American Hospital Association: www.aha.org/advocacy-issues/tools-resources/advisory/2011/110722-quality-adv.pdf

•AmericanMedicalDirectorsAssociationwww.amda.com/governance/resolutions/J11.cfm

•AmericanPharmacistsAssociationclickhere•American Public Health Association www.apha.org/advocacy/policy/policysearch/default.htm?id=1410

Stay current with FREE subscriptions

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Vaccinate Adults, andouremailnewsservice,IAC Express,arepacked

withup-to-dateinformation.

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•AssociationforProfessionalsinInfectionControlandEpidemiologyclickhere

•InfectiousDiseasesSocietyofAmericaclickhere

•SocietyforHealthcareEpidemiologyofAmericawww.jstor.org/stable/10.1086/656558

Youcanfindadditionalinformationaboutmanda-tory influenzavaccination forHCP, including alistofmorethan100healthcaresettingsthathaveimplementedmandatory vaccination programs.AccessIAC’sHonorRollforPatientSafetywebsectionatwww.immunize.org/honor-roll.

Looking for patient handouts or staff educational materials?

Visit www.immunize.org/handouts





http://www.immunize.org/aboutus/iacstaff.asp

http://www.immunize.org/aboutus/iacstaff.asp





http://www.aafp.org/online/en/home/clinical/immunizationres/influenza/mandatoryinfluenza.html



http://pediatrics.aappublications.org/content/early/2010/09/13/peds.2010-2376.abstract



http://www.acponline.org/clinical_information/resources/adult_immunization/flu_hcw.pdf



http://www.aha.org/advocacy-issues/tools-resources/advisory/2011/110722-quality-adv.pdf



http://www.amda.com/governance/resolutions/J11.cfm

http://www.amda.com/governance/resolutions/J11.cfm

http://www.pharmacist.com/AM/Template.cfm?Section=House_of_Delegates&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=25910

http://www.apha.org/advocacy/policy/policysearch/default.htm?id=1410



http://www.immunize.org/nt




http://www.apic.org/Content/NavigationMenu/GovernmentAdvocacy/PublicPolicyLibrary/APIC_Influenza_Immunization_of_HCP_12711.PDF

http://www.idsociety.org/uploadedFiles/IDSA/Policy_and_Advocacy/Current_Topics_and_Issues/Immunizations_and_Vaccines/Health_Care_Worker_Immunization/Statements/IDSA%20Policy%20on%20Mandatory%20Immunization%20Revision%20083110.pdf

http://www.idsociety.org/uploadedFiles/IDSA/Policy_and_Advocacy/Current_Topics_and_Issues/Immunizations_and_Vaccines/Health_Care_Worker_Immunization/Statements/IDSA%20Policy%20on%20Mandatory%20Immunization%20Revision%20083110.pdf

http://www.jstor.org/stable/10.1086/656558


http://www.immunize.org/handouts

from the Immunization Action Coalition — · 1 IAC’s Honor Roll Focuses on Mandatory Influenza...

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